CPT code 35666 is used for a surgical procedure involving an arterial bypass from the femoral to the anterior or posterior tibial or peroneal artery.
CPT code 35666 is used to describe a surgical procedure involving an arterial bypass graft. Specifically, it refers to the creation of a bypass from the femoral artery to both the anterior and posterior tibial arteries or the peroneal artery. This procedure is typically performed to restore adequate blood flow to the lower extremities, often in cases where there is significant blockage or narrowing of the arteries due to conditions such as peripheral artery disease (PAD). The bypass graft can be created using a vein from the patient's own body or a synthetic graft material, and the goal is to improve circulation and alleviate symptoms such as pain or ulcers in the legs and feet.
For CPT code 35666, which involves arterial bypass grafting, 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 increased complexity or time.
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 a procedure or service was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is applicable.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of a surgical team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This is used when the same procedure is repeated by a different provider.
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 when a 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 is used when a procedure performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
13. Modifier 99 - Multiple Modifiers: This is used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It's important to use them appropriately to avoid claim denials or delays.
The CPT code 35666 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 35666 is reimbursed by Medicare depends on several factors, including its inclusion in the MPFS and the specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your region.
Each MAC has the authority to interpret national Medicare policies and may have local coverage determinations (LCDs) that affect the reimbursement of certain CPT codes. Therefore, it is essential to verify with the relevant MAC to determine if CPT code 35666 is covered and reimbursed in your specific area. Additionally, providers should ensure that all documentation and billing practices align with Medicare's guidelines to facilitate proper reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 35666, RevFind provides unparalleled insight into your revenue streams. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your financial performance.
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
