CPT code 35111 is used to describe the procedure for repairing a defect in an artery, ensuring accurate documentation and reimbursement.
CPT code 35111 is used to describe the surgical procedure for repairing a defect in an artery. This code is typically utilized when a healthcare provider performs a direct repair on an arterial defect, which may be due to trauma, disease, or other medical conditions that compromise the integrity of the artery. The procedure involves techniques such as suturing or patching to restore the artery's normal function and ensure proper blood flow. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the complex surgical services they deliver.
For CPT code 35111, which pertains to the repair of a defect in an artery, the following modifiers may be applicable:
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 50 (Bilateral Procedure): If the procedure is performed on both sides of the body, this modifier should be used to indicate a bilateral procedure.
3. Modifier 51 (Multiple Procedures): Apply this modifier when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the procedure is 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 should be used to indicate the involvement of both surgeons.
6. Modifier 66 (Surgical Team): This modifier is applicable when a surgical team is necessary to perform the procedure, indicating the complexity and need for multiple specialists.
7. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same physician needs to repeat the procedure on the same day.
8. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a different physician repeats the procedure on the same day.
9. Modifier 78 (Unplanned Return to the Operating/Procedure Room): If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is applicable.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier if the procedure is unrelated to the original surgery and occurs during the postoperative period.
11. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, this modifier should be used to indicate their involvement.
12. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is necessary for the procedure.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Use this modifier when an assistant surgeon is required because a qualified resident surgeon is not available.
14. Modifier 99 (Multiple Modifiers): When more than four modifiers are necessary to describe the service, this modifier indicates the use of multiple modifiers.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific policies when applying modifiers.
The CPT code 35111 is subject to reimbursement by Medicare, but its reimbursement status depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) in your region.
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 35111 is reimbursed can vary based on local coverage determinations (LCDs) and other policies established by the MAC.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 35111 with their respective MAC to ensure compliance and accurate billing.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including CPT code 35111, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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