CPT code 35665 is used for a surgical procedure involving an arterial bypass from the iliac to the femoral artery.
CPT code 35665 is used to describe a surgical procedure known as an iliofemoral artery bypass. This procedure involves creating a bypass around a blocked or narrowed section of the iliac or femoral artery, which are major blood vessels in the pelvis and thigh, respectively. The bypass is typically performed using a graft, which can be made from a synthetic material or a vein harvested from the patient. This procedure is often necessary to restore adequate blood flow to the lower extremities, alleviating symptoms such as pain and preventing more severe complications like tissue damage or limb loss.
For CPT code 35665, which pertains to an arterial bypass from the iliac to the femoral artery, 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 factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that it was a bilateral procedure.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 52 - Reduced Services: This modifier is applicable if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. 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 were involved.
7. Modifier 66 - Surgical Team: When a team of surgeons is necessary to perform the procedure, this modifier is used to indicate the involvement of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure, this modifier is used to indicate the repetition.
9. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician.
10. 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 is used when a patient needs to return to the operating room for a related procedure during the postoperative period.
11. 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.
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 guidelines and payer policies to determine the appropriate use of each modifier.
CPT code 35665 is subject to reimbursement by Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
The MPFS outlines the payment rates for services covered by Medicare, and each MAC may have additional local coverage determinations that affect reimbursement.
Therefore, healthcare providers should verify the reimbursement status of CPT code 35665 by consulting the MPFS and the relevant MAC's policies to ensure compliance and proper billing practices.
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