CPT code 35654 is used for a surgical procedure involving an arterial bypass from the axillary to femoral artery, including a femoral bypass.
CPT code 35654 is used to describe a surgical procedure known as an axillofemoral-femoral artery bypass. This procedure involves creating a bypass from the axillary artery, which is located near the armpit, to the femoral artery in the thigh, and then extending to the opposite femoral artery. It is typically performed to circumvent blockages in the main arteries supplying blood to the lower extremities, thereby improving blood flow and alleviating symptoms associated with peripheral artery disease. This code is crucial for accurate billing and documentation of the specific surgical intervention performed.
For CPT code 35654, which pertains to an arterial bypass from axillary to femoral-femoral, 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 more than one procedure was 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 that both surgeons are involved.
5. Modifier 66 - Surgical Team: When a surgical team is necessary to perform the procedure, this modifier indicates that a team approach was required.
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: This modifier is used when a different physician repeats the procedure 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: 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: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier is applicable.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help perform the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Indicates that a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 35654 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. Whether CPT code 35654 is reimbursed by Medicare depends on several factors, including its inclusion in the MPFS and any specific guidelines or coverage determinations made by the Medicare Administrative Contractor (MAC) responsible for the region where the service is provided.
MACs are private organizations contracted by Medicare to process claims and make coverage decisions at the local level. They have the authority to issue Local Coverage Determinations (LCDs) that can affect whether a particular CPT code, such as 35654, is reimbursed. Therefore, healthcare providers should consult the MPFS and their respective MAC's guidelines to determine the reimbursement status of CPT code 35654. Additionally, providers should ensure that all necessary documentation and medical necessity criteria are met to facilitate successful reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 35654, and by individual payer. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can enhance your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
