CPT code 35691 is used for the surgical procedure of transferring an artery from the vertebral to the carotid to improve blood flow.
CPT code 35691 is used to describe the surgical procedure of arterial transposition, specifically involving the vertebral and carotid arteries. This procedure is typically performed to improve blood flow to the brain by repositioning these arteries. It is often indicated in cases where there is a need to correct or bypass blockages or abnormalities that could lead to compromised cerebral circulation. The code is utilized by healthcare providers to accurately document and bill for this complex vascular surgery.
For CPT code 35691, which involves arterial transposition 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 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 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 used to indicate the shared responsibility.
5. Modifier 66 - Surgical Team: This modifier is applicable 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: 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: 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 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 is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to use them appropriately to avoid claim denials or delays.
The CPT code 35691 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered under Medicare Part B. To determine if CPT code 35691 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a specific service, such as one billed under CPT code 35691, is reimbursed in their jurisdiction. Providers should check with their respective MAC to ensure compliance with any local policies or additional documentation requirements that might influence reimbursement for this code.
In summary, while CPT code 35691 can be reimbursed by Medicare, providers must verify its inclusion in the MPFS and adhere to any specific guidelines or requirements set forth by their MAC to ensure successful reimbursement.
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