CPT code 10035 is for the percutaneous device placement in soft tissue, guided by imaging, for the first lesion.
CPT code 10035 is used for the percutaneous placement of a device into soft tissue under imaging guidance. This code specifically refers to the initial placement of the device, which is often done to facilitate drainage, biopsy, or other therapeutic interventions. The imaging guidance ensures accurate placement and can involve techniques such as ultrasound, fluoroscopy, or CT scans.
For CPT code 10035, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. For example, if a radiologist interprets the imaging but does not own the equipment.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. For example, if the imaging equipment is owned by the facility but the interpretation is done by a different provider.
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. For instance, if multiple imaging procedures are performed on different anatomical sites.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician performs the same procedure more than once on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician on the same day.
6. 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.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
9. Modifier XE - Separate Encounter: This modifier is used to indicate that a service was performed during a separate encounter on the same day.
10. Modifier XS - Separate Structure: This modifier is used to indicate that a service was performed on a separate organ/structure.
11. Modifier XP - Separate Practitioner: This modifier is used to indicate that a service was performed by a different practitioner.
12. Modifier XU - Unusual Non-Overlapping Service: This modifier is used to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 10035 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) for your region. Each MAC may have specific guidelines and coverage determinations that impact whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult both the MPFS and your regional MAC to confirm the reimbursement details for CPT code 10035.
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