CPT code 35693 is used for the surgical procedure involving the transposition of the subclavian artery to improve blood flow.
CPT code 35693 is used to describe the surgical procedure of arterial transposition of the subclavian artery. This procedure involves repositioning the subclavian artery, which is one of the major arteries that supply blood to the arms, neck, and head. The transposition is typically performed to improve blood flow or to address certain vascular conditions, such as subclavian steal syndrome or other obstructions that may impede proper circulation. This code is utilized by healthcare providers to accurately document and bill for the specific surgical intervention performed.
For CPT code 35693, which involves arterial transposition of the subclavian, 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 used to avoid bundling issues.
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): If the procedure requires a surgical team due to its complexity, this modifier is used.
6. Modifier 76 (Repeat Procedure by Same Physician): This is used when the same procedure is repeated by the same physician.
7. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the procedure is repeated 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 is used when a related procedure is performed during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier indicates that an unrelated procedure was performed during the postoperative period.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Indicates that a minimum assistant surgeon was required.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 35693 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 policies of the specific Medicare Administrative Contractor (MAC) overseeing the region where the service is provided.
The MPFS outlines the payment rates for services covered by Medicare Part B, and CPT code 35693 must be listed with an assigned relative value unit (RVU) to be eligible for reimbursement.
Additionally, MACs have the authority to make local coverage determinations (LCDs) that can affect the reimbursement status of specific CPT codes.
Therefore, healthcare providers should verify the reimbursement status of CPT code 35693 by consulting the MPFS and the relevant MAC's guidelines to ensure compliance and proper billing practices.
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