CPT code 35132 is used for procedures involving the repair of a ruptured artery in the groin area, ensuring accurate documentation and reimbursement.
CPT code 35132 is used to describe the surgical procedure for repairing a ruptured artery in the groin area. This code is specifically assigned to operations where a surgeon addresses a tear or break in an artery located in the groin, which is a critical area due to the major blood vessels that pass through it. The procedure typically involves accessing the affected artery, controlling any bleeding, and then repairing the rupture to restore normal blood flow and prevent further complications. This code is essential for accurate billing and documentation of the surgical intervention performed.
For CPT code 35132, which pertains to the repair of an artery rupture in the groin, 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 factors such as increased complexity or the presence of significant scarring or adhesions.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure was one of several performed.
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 clarify that the procedures are not components of a more comprehensive service.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: If the procedure requires a team of surgeons due to its complexity, this modifier is used to denote the involvement of a surgical team.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same physician needs to repeat the procedure for the same patient on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure on the same day, this modifier is used.
8. 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 an unplanned return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always ensure that the use of modifiers is supported by appropriate documentation in the patient's medical record.
CPT code 35132, which involves the repair of an artery rupture in the groin, is subject to reimbursement by Medicare, contingent upon several factors. Primarily, the Medicare Physician Fee Schedule (MPFS) serves as a critical reference point for determining the reimbursement rates for specific CPT codes. The MPFS outlines the payment amounts for services provided by physicians and other healthcare professionals, including surgical procedures like those represented by CPT code 35132.
However, it's important to note that the reimbursement for CPT code 35132 can also be influenced by the local policies of the Medicare Administrative Contractor (MAC) that oversees the specific geographic region where the service is provided. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect whether a particular service is covered and reimbursed.
Therefore, while CPT code 35132 is generally reimbursable under Medicare, healthcare providers should verify the specific coverage criteria and reimbursement rates with their regional MAC to ensure compliance with any local policies or documentation requirements that may apply.
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