CPT code 35131 is used for procedures involving the repair of an artery defect, ensuring accurate documentation and reimbursement for healthcare services.
CPT code 35131 is used to describe the surgical procedure for repairing a defect in an artery. This code is typically applied when a surgeon performs a direct repair on an artery that has been damaged or has a defect, such as an aneurysm or a traumatic injury. The procedure involves techniques to restore the integrity and function of the artery, ensuring proper blood flow and reducing the risk of complications. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, as it helps healthcare providers receive appropriate reimbursement for the services rendered.
For CPT code 35131, which involves the repair of a defect in an artery, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and the reasons for their use:
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 factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier indicates that the service was bilateral.
3. Modifier 51 - Multiple Procedures: This is used when multiple procedures are performed during the same surgical session. It helps to indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: This modifier is applicable when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: This is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used.
7. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of a surgical team.
8. Modifier 76 - Repeat Procedure by Same Physician: If the same physician repeats the procedure, this modifier is used to indicate the repetition.
9. Modifier 77 - Repeat Procedure by Another Physician: This is used when a procedure is repeated by a different physician.
10. 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 when a patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This is used when a procedure performed during the postoperative period is unrelated to the original procedure.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: This is used when a minimum assistant surgeon is required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
15. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate that multiple modifiers apply.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review the specific guidelines and payer policies to determine the appropriate use of each modifier.
CPT code 35131 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) determines the payment rates for services covered under Medicare Part B, including surgical procedures like those associated with CPT code 35131. The reimbursement amount can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific region. It is essential for healthcare providers to verify the specific reimbursement details with their local MAC to ensure accurate billing and compliance with Medicare guidelines.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 35131. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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
