CPT code 35663 is used for a surgical procedure involving an arterial bypass from one iliac artery to another.
CPT code 35663 is used to describe a surgical procedure known as an "arterial bypass graft" specifically between the iliac arteries. This procedure involves creating a bypass around a blocked or narrowed section of the iliac artery, which is a major artery in the pelvis that supplies blood to the lower limbs. The bypass is typically constructed using a graft, which can be a section of another blood vessel from the patient's body or a synthetic material. This procedure is often performed to restore adequate blood flow to the lower extremities, alleviating symptoms such as pain and improving mobility for patients with peripheral artery disease or other vascular conditions affecting the iliac arteries.
For CPT code 35663, which pertains to an arterial bypass graft procedure, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or additional work that was not anticipated.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
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 often used to overcome National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: This modifier is used when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.
5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the services of a surgical team, indicating that multiple professionals were involved in the surgery.
6. 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 when a patient returns to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to assist the primary surgeon during the procedure.
8. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
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 the use of modifiers can vary between insurance providers.
The CPT code 35663 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used to reimburse physicians and other healthcare providers for services rendered to Medicare beneficiaries. Whether CPT code 35663 is reimbursed by Medicare depends on several factors, including its inclusion in the MPFS and the determination of coverage by the relevant Medicare Administrative Contractor (MAC).
MACs are private organizations contracted by Medicare to process claims and determine coverage policies in specific geographic regions. They play a crucial role in interpreting national Medicare policies and applying them to local contexts. Therefore, the reimbursement for CPT code 35663 may vary depending on the MAC's local coverage determinations (LCDs) and any specific guidelines they have established.
Healthcare providers should consult the MPFS to verify if CPT code 35663 is listed and check with their regional MAC for any additional coverage criteria or documentation requirements that might affect reimbursement. This ensures compliance with Medicare's billing practices and maximizes the likelihood of successful reimbursement.
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