CPT code 35180 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35180 is used to describe the surgical procedure for repairing a lesion in a blood vessel. This code is typically utilized when a healthcare provider performs a surgical intervention to fix a defect or damage in a blood vessel, which may be necessary due to conditions such as aneurysms, trauma, or other vascular abnormalities. The procedure aims to restore normal blood flow and prevent complications associated with the lesion. This code is part of the Current Procedural Terminology (CPT) system, which standardizes the reporting of medical, surgical, and diagnostic services to facilitate communication and billing between healthcare providers and payers.
For CPT code 35180, which pertains to the repair of a blood vessel lesion, 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 time.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It indicates that the procedure is 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 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 used to indicate the collaborative effort.
5. Modifier 66 - Surgical Team: This modifier is applicable when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
6. 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.
7. 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.
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 a 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 it 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 verify with the latest coding guidelines and payer-specific policies, as requirements may vary.
CPT code 35180 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). The MPFS is a comprehensive listing of fees used by Medicare to determine the payment rates for services provided by physicians and other healthcare professionals. Whether CPT code 35180 is reimbursed by Medicare depends on its inclusion in the MPFS and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
Each MAC has the authority to interpret national Medicare policies and establish local coverage determinations (LCDs) that can affect the reimbursement of specific CPT codes. Therefore, it is essential for healthcare providers to consult the MPFS and the relevant MAC's guidelines to confirm if CPT code 35180 is reimbursed in their specific jurisdiction. Additionally, providers should ensure that all necessary documentation and coding requirements are met to facilitate accurate and timely reimbursement.
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