CPT code 32035 is for a thoracostomy procedure involving rib resection, used by healthcare providers to classify and document medical services.
CPT code 32035 is used to describe a medical procedure known as a thoracostomy with rib resection. This procedure involves creating an opening in the chest wall to allow for drainage or access to the pleural space, which is the area between the lungs and the chest wall. The addition of rib resection means that a portion of a rib is surgically removed to facilitate better access or drainage. This procedure is typically performed to treat conditions such as pleural effusion, pneumothorax, or empyema, where fluid or air needs to be evacuated from the pleural space to improve lung function and patient comfort.
For CPT code 32035, which involves a thoracostomy with rib resection, 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 difficulty of the case.
2. Modifier 51 - Multiple Procedures: If the thoracostomy with rib resection is performed in conjunction with other procedures during the same surgical session, this modifier indicates that multiple procedures were performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if the thoracostomy is performed in a different anatomical site or for a different reason than other procedures.
4. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that each surgeon is performing a distinct part of the procedure.
5. Modifier 76 - Repeat Procedure by Same Physician: If the procedure needs to be repeated by the same physician, this modifier is used to indicate that the repeat procedure was necessary.
6. Modifier 77 - Repeat Procedure by Another Physician: Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.
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 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the thoracostomy with rib resection is performed during the postoperative period of another procedure, and it is unrelated, this modifier is applicable.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 32035 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). Whether this code is reimbursed by Medicare depends on several factors, including the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) that governs the region where the service is provided.
Each MAC may have different interpretations and local coverage determinations that affect reimbursement. Therefore, it is essential for healthcare providers to verify the coverage and reimbursement status of CPT code 32035 with their respective MAC to ensure compliance and proper billing practices.
Additionally, providers should consult the MPFS to understand the payment rates and any applicable modifiers that might influence reimbursement for this procedure.
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