CPT code 35182 is used to describe the procedure for repairing a lesion in a blood vessel, ensuring accurate documentation for healthcare services.
CPT code 35182 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 repair on a blood vessel that has been damaged or has developed an abnormality, such as an aneurysm or a tear. The procedure aims to restore the normal function and integrity of the blood vessel, ensuring proper blood flow and reducing the risk of complications. This code is important for accurate billing and documentation in the healthcare revenue cycle, as it helps ensure that the provider is reimbursed appropriately for the specialized surgical service performed.
When dealing with CPT code 35182 for the repair of a blood vessel lesion, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used, along with the reasons for their application:
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 additional time spent.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that more than one procedure was conducted.
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: If the procedure requires a surgical team due to its complexity, this modifier is used to indicate the involvement of multiple professionals.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same physician repeats a procedure on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: If a procedure is repeated on the same day by a different physician, this modifier is applicable.
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 is used when a patient needs to 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 performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier is used to indicate their involvement.
11. Modifier 81 - Minimum Assistant Surgeon: This is used when an assistant surgeon is required for a minimal portion of the procedure.
12. 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.
These modifiers help provide additional context and detail about the procedure, ensuring accurate billing and reimbursement. It's important to review the specific circumstances of each case to determine the appropriate modifiers to apply.
CPT code 35182, which involves the repair of a blood vessel lesion, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines whether a specific CPT code is reimbursable and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals under Medicare Part B.
However, it's important to note that the reimbursement for CPT code 35182 can also be influenced by the local policies of the Medicare Administrative Contractor (MAC) that services your geographic area. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that can affect whether a particular service is covered and reimbursed.
Therefore, to ascertain if CPT code 35182 is reimbursed by Medicare, healthcare providers should consult the MPFS for the national payment rate and check with their specific MAC for any local coverage policies that might apply. This dual approach ensures that providers are fully informed about the reimbursement potential for this procedure under Medicare.
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