CPT code 35142 is used for procedures involving the repair of a ruptured artery in the thigh, ensuring accurate procedure documentation.
CPT code 35142 is used to describe the surgical procedure for repairing a ruptured artery in the thigh. This code is specifically assigned to operations where a surgeon addresses a break or tear in the arterial wall within the thigh region. The procedure involves accessing the affected artery, controlling any bleeding, and then repairing the rupture to restore proper blood flow and prevent further complications. This code is crucial for accurate billing and documentation, ensuring that healthcare providers are reimbursed appropriately for the specialized care provided during such a critical surgical intervention.
When billing for the procedure associated with CPT code 35142, "Repair artery rupture thigh," it is important to consider the use of modifiers to provide additional information about the service rendered. Here is a list of potential modifiers that could be used with this CPT code, along with 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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was 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 identify procedures that are not typically reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider.
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 when a patient requires a 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 modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required during the procedure.
10. 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.
11. 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 in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
CPT code 35142, which involves the repair of an artery rupture in the thigh, is subject to reimbursement by Medicare, contingent upon its inclusion in the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. To determine if CPT code 35142 is reimbursed, healthcare providers should consult the MPFS to verify its status and associated reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations regarding coverage and payment for specific CPT codes within their jurisdiction. Therefore, it is advisable for healthcare providers to check with their respective MAC to confirm the reimbursement status of CPT code 35142, as local coverage determinations (LCDs) may influence whether the code is reimbursed in specific regions.
Discover the power of MD Clarity's RevFind software to ensure you're capturing every dollar owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 35142, RevFind provides unparalleled insight into your revenue streams. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and enhance your financial performance.
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
