CPT code 35188 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35188 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 correct or remove an abnormality or damage within a blood vessel. Such lesions could be due to various causes, including trauma, disease, or congenital defects. The procedure aims to restore normal blood flow and prevent complications such as bleeding or restricted circulation. This code is essential for accurate billing and documentation of the specific surgical service provided to the patient.
For CPT code 35188, "Repair blood vessel lesion," the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if 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 multiple procedures were performed.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are actively involved in the procedure.
6. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform the procedure due to its complexity.
7. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the procedure on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician on the same day.
9. 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 related procedure is required during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier for procedures that are unrelated to the original procedure during the postoperative period.
11. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier when an assistant surgeon is required on a limited basis.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
14. Modifier 99 - Multiple Modifiers: If more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are being used.
Each modifier should be used in accordance with the specific circumstances of the procedure and the payer's guidelines. Proper documentation is essential to support the use of any modifier.
CPT code 35188, which involves the repair of a blood vessel lesion, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource in determining whether a specific CPT code is reimbursed and at what rate. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals to Medicare beneficiaries.
However, the reimbursement for CPT code 35188 is not solely determined by the MPFS. Medicare Administrative Contractors (MACs) play a significant role in this process. MACs are private organizations contracted by Medicare to process claims and determine coverage policies for specific regions. They have the authority to make local coverage determinations (LCDs) that can affect whether a particular service is reimbursed in their jurisdiction.
Therefore, while CPT code 35188 may be listed on the MPFS, healthcare providers should consult their specific MAC to confirm coverage and reimbursement details. This ensures compliance with any regional policies or additional documentation requirements that may influence the reimbursement process.
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