CPT code 35694 is used for the surgical procedure of transferring the subclavian artery to the carotid artery to improve blood flow.
CPT code 35694 is used to describe the surgical procedure of arterial transposition from the subclavian artery to the carotid artery. This procedure involves rerouting or repositioning the subclavian artery to connect it directly to the carotid artery. It is typically performed to improve blood flow to the brain or upper extremities when there is a blockage or narrowing in the arteries that supply these areas. This code is utilized by healthcare providers to accurately document and bill for this specific type of vascular surgery.
For CPT code 35694, which involves arterial transposition from the subclavian to the carotid, 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 is one of several performed.
3. Modifier 52 - Reduced Services: This modifier is applicable 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: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are involved in the procedure.
6. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform the procedure due to its complexity.
7. 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 if the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help with the procedure.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association and the payer's policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
CPT code 35694 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 35694 is reimbursed by Medicare depends on several factors, including the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and have the authority to make determinations on coverage and reimbursement based on local coverage determinations (LCDs) and national coverage determinations (NCDs).
Therefore, it is essential for healthcare providers to consult the MPFS and their respective MAC to verify if CPT code 35694 is reimbursed and to understand any specific billing requirements or documentation needed for successful claim submission.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 35694. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and ensure you're receiving the full reimbursement you deserve.
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