CPT code 35112 is used for the procedure involving the repair of a ruptured artery in the spleen.
CPT code 35112 is used to describe the surgical procedure for repairing a ruptured artery in the spleen. This code is specifically assigned to the operation where a surgeon addresses a tear or break in the arterial blood vessel supplying the spleen, which is crucial for controlling bleeding and restoring proper blood flow. This procedure is often necessary in cases of trauma or injury to the spleen, and the use of this code helps in accurately documenting and billing for the surgical intervention performed.
For CPT code 35112, which pertains to the repair of an artery rupture in the spleen, 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 complications or unexpected findings during the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates 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 is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is applicable.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
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 is used when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 35112 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining if a specific CPT code is reimbursed by Medicare. The MPFS outlines the payment rates for services and procedures covered by Medicare Part B, including surgical procedures like those represented by CPT code 35112.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make coverage determinations based on local policies. They may have specific guidelines or requirements that influence whether CPT code 35112 is reimbursed in their jurisdiction.
To determine if CPT code 35112 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year to check if the code is listed and review any relevant local coverage determinations (LCDs) or national coverage determinations (NCDs) issued by the MACs. This will provide clarity on the reimbursement status and any conditions that must be met for Medicare to cover the procedure.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 35112, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and protect your bottom line.
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
