CPT code 35686 is used for procedures involving bypass grafts or arteriovenous fistula patency to ensure proper blood flow in patients.
CPT code 35686 is used to describe a surgical procedure that involves the creation of a bypass graft or the maintenance of an arteriovenous (AV) fistula patency. This code is typically utilized in vascular surgery to ensure proper blood flow, either by redirecting blood around a blocked or narrowed artery using a graft or by ensuring that an AV fistula, often used for dialysis access, remains open and functional. This procedure is crucial for patients who require improved blood circulation or those undergoing regular dialysis treatments.
For CPT code 35686, which pertains to bypass graft or arteriovenous fistula patency, 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 other factors that increase the complexity of the procedure.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. 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.
5. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is applicable.
6. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the skills of a surgical team.
7. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier is used to indicate the repetition.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician.
9. 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.
10. 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 is unrelated to the original procedure.
11. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when an assistant surgeon is required on a limited basis.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required 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 verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 35686 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 and their respective reimbursement rates. However, the actual reimbursement for CPT code 35686 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 apply them to local circumstances, which can affect the reimbursement process. Therefore, healthcare providers should consult their specific MAC for detailed information regarding the reimbursement of CPT code 35686 in their region.
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