CPT code 35091 is used for the procedure involving the repair of a defect in an artery, ensuring proper blood flow and vessel integrity.
CPT code 35091 is used to describe the surgical procedure for repairing a defect in an artery. This code is specifically applied when a surgeon performs a direct repair on an arterial defect, which may be due to trauma, disease, or a congenital condition. The procedure involves techniques such as suturing or patching to restore the integrity and function of the affected artery, ensuring proper blood flow and minimizing the risk of complications. This code is essential for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the complex and skilled work involved in vascular repair.
When dealing with CPT code 35091 for the repair of an artery defect, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to increased complexity or time.
2. Modifier 51 - Multiple Procedures: Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was carried out.
3. Modifier 52 - Reduced Services: This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Use this modifier 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, this modifier indicates that both surgeons worked together as primary surgeons.
6. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires a surgical team.
7. Modifier 76 - Repeat Procedure by Same Physician: Apply this modifier if the same procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier when the procedure is repeated by a different physician.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used when a patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier for procedures that are unrelated to the original surgery but occur during the postoperative period.
11. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier when a minimum assistant surgeon is needed.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary due to the unavailability of a qualified resident.
14. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 35091 is subject to reimbursement by Medicare, but its reimbursement is contingent upon several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
The MPFS provides a comprehensive list of services covered by Medicare and assigns relative value units (RVUs) to each service, which are used to determine reimbursement rates.
However, the final determination of whether CPT code 35091 is reimbursed can vary based on local coverage determinations (LCDs) and other policies established by the MAC.
Therefore, healthcare providers should verify the specific reimbursement details with their regional MAC to ensure compliance and accurate billing.
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