CPT code 35695 is used for the surgical procedure involving the transposition of the carotid artery to the subclavian artery.
CPT code 35695 is used to describe the surgical procedure of arterial transposition involving the carotid and subclavian arteries. This procedure typically involves repositioning or rerouting these arteries to improve blood flow or to address certain vascular conditions. It is a complex operation often performed to treat conditions such as subclavian steal syndrome or to ensure adequate blood supply to the brain and upper extremities. This code is utilized by healthcare providers to accurately document and bill for the specific surgical intervention performed.
For CPT code 35695, which involves arterial transposition of the carotid and subclavian arteries, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: This modifier is used if the procedure is performed on both sides of the body during the same surgical session. It indicates that the procedure was conducted bilaterally.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was carried out.
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 may be necessary if the procedure is performed in conjunction with other services that are not typically reported together.
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 collaborative effort.
5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the expertise of a surgical team, indicating that multiple professionals were involved in the surgery.
6. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required to aid in the procedure, this modifier is used to denote their involvement.
7. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific payer guidelines as they may have unique requirements for modifier usage.
The CPT code 35695 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used to reimburse physicians and other healthcare providers for services rendered to Medicare beneficiaries. Whether CPT code 35695 is reimbursed by Medicare depends on several factors, including its inclusion in the MPFS and the specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your region.
MACs are responsible for interpreting national Medicare policies and may have local coverage determinations (LCDs) that affect the reimbursement of certain procedures. Therefore, it is crucial to verify with the applicable MAC to determine if CPT code 35695 is covered and reimbursed in your specific area. Additionally, providers should ensure that all documentation and billing practices align with Medicare's requirements to facilitate proper reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 35695, RevFind provides unparalleled insights into your revenue streams. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your financial performance.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
