CPT code 35650 is used for a surgical procedure involving an arterial bypass from one axillary artery to another axillary artery.
CPT code 35650 is used to describe a surgical procedure known as an axillary-axillary artery bypass. This procedure involves creating a bypass between the axillary arteries, which are located in the armpit area. It is typically performed to reroute blood flow around a blocked or narrowed section of an artery, thereby improving circulation to the upper extremities. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the complex surgical services they deliver.
For CPT code 35650, which pertains to an axillary-axillary artery bypass, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same operative session.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier is used to indicate the involvement of both surgeons.
5. Modifier 66 - Surgical Team: This modifier is applicable when a surgical team is necessary to perform the procedure due to its complexity.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier is used.
7. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure on the same day, this modifier is applicable.
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: This modifier is used if the patient needs to return 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: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to help with the procedure, this modifier is used.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific payer guidelines as they may have unique requirements for modifier usage.
CPT code 35650 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) for the specific region.
The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the final decision on reimbursement can vary based on local coverage determinations (LCDs) made by the MACs, which are responsible for interpreting national policies and setting regional guidelines.
Therefore, healthcare providers should verify the specific reimbursement details for CPT code 35650 with their respective MAC to ensure compliance and accurate billing.
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