CPT code 35647 is used for a surgical procedure involving an aortofemoral artery bypass to improve blood flow in the lower extremities.
CPT code 35647 is used to describe a surgical procedure known as an aortofemoral bypass. This procedure involves creating a bypass around a blocked or narrowed section of the aorta, the main artery that carries blood from the heart to the rest of the body, to the femoral artery in the thigh. The bypass is typically performed using a graft, which can be made from synthetic material or a vein from the patient's own body. This procedure is often necessary to restore adequate blood flow to the lower extremities in patients with severe peripheral artery disease or other vascular conditions that impede circulation.
For CPT code 35647, which involves an aortofemoral artery bypass, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session. This modifier indicates that multiple distinct procedures were carried out.
3. Modifier 59 - Distinct Procedural Service: Utilized to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of the procedure.
5. Modifier 66 - Surgical Team: Applied when a complex procedure requires the services of a surgical team.
6. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Used if the same procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a patient returns to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Applied when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary and a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. It is important to review the specific guidelines and payer policies when applying these modifiers.
The CPT code 35647 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered by Medicare. To determine if CPT code 35647 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and what the associated reimbursement rate is.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations about coverage and payment for specific services in their respective jurisdictions. Therefore, it is essential for healthcare providers to check with their local MAC to confirm if CPT code 35647 is reimbursed and to understand any specific billing requirements or documentation needed to support the claim.
In summary, while CPT code 35647 may be reimbursed by Medicare, providers must verify its inclusion in the MPFS and consult their MAC for specific guidance on coverage and reimbursement.
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