CPT code 35656 is for a surgical procedure involving an arterial bypass from the femoral to the popliteal artery.
CPT code 35656 is used to describe a surgical procedure known as a femoral-popliteal artery bypass. This procedure involves creating a bypass around a blocked or narrowed section of the femoral or popliteal artery, which are major blood vessels in the leg. The bypass is typically constructed using a graft, which can be a piece of vein taken from another part of the patient's body or a synthetic material. This procedure is performed to restore adequate blood flow to the lower leg and foot, often to relieve symptoms of peripheral artery disease (PAD) or to prevent complications such as tissue damage or ulcers.
For CPT code 35656, which involves an arterial bypass from the femoral to the popliteal artery, the following modifiers may be applicable:
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. It indicates that the procedure was performed bilaterally.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It helps in identifying that more than one procedure was carried out.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is particularly useful when procedures are not normally reported together but are appropriate under the circumstances.
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 each surgeon performed a distinct part of the procedure.
5. Modifier 66 - Surgical Team: This modifier is used when a surgical team is necessary to perform the procedure. It indicates that the complexity of the procedure required multiple professionals.
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 to denote the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated on the same day by a different physician.
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 when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 35656 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including 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 listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC, which administers Medicare benefits in different regions, may have specific guidelines and local coverage determinations that influence whether and how a particular CPT code like 35656 is reimbursed.
Providers should consult the MPFS for the national payment rate and check with their local MAC for any additional coverage criteria or documentation requirements that might affect reimbursement for this code.
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