CPT code 35685 is used for procedures involving the evaluation of bypass graft patency or patch, crucial for tracking surgical outcomes.
CPT code 35685 is used to describe a surgical procedure involving the revision of a bypass graft to ensure its patency or the application of a patch to repair or reinforce the graft. This code is typically utilized in vascular surgery, where maintaining the open and functional status of a bypass graft is crucial for proper blood flow. The procedure may involve techniques such as removing blockages, repairing defects, or reinforcing the graft with a patch to prevent future complications. This code is essential for accurate billing and documentation of the specific surgical intervention performed to maintain or restore the effectiveness of a bypass graft.
For CPT code 35685, which involves bypass graft patency or patch procedures, 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 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure was 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 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 skills of a surgical team.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician repeats the procedure on the same day, this modifier is used to indicate that the procedure was repeated.
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 when a patient requires a 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 a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because 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. Always consult the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 35685 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement for CPT code 35685 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and establish local coverage determinations, which can influence whether and how a particular service is reimbursed. Therefore, healthcare providers should consult their respective MAC for detailed information on the reimbursement criteria and rates applicable to CPT code 35685 in their region.
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