CPT code 35190 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35190 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 direct repair on a blood vessel that has been damaged or has developed an abnormality, such as an aneurysm or a tear. The procedure involves accessing the affected vessel, removing or correcting the lesion, and restoring the vessel's integrity to ensure proper blood flow. This code is essential for accurate billing and documentation in the healthcare revenue cycle, as it helps providers receive appropriate reimbursement for the specialized surgical services rendered.
For CPT code 35190, "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 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that the service was bilateral.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier indicates that multiple services were provided.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service was less than usually required.
5. 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 used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 62 - Two Surgeons: If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons were necessary and each performed a distinct part of the procedure.
7. Modifier 66 - Surgical Team: When a team of surgeons is required to perform the procedure, this modifier indicates that the complexity of the procedure necessitated a team approach.
8. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same physician needs to repeat the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure on the same day, this modifier should be used.
10. 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 the patient requires a return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be applied.
12. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required to help perform the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: If a minimum assistant surgeon is required, this modifier indicates their involvement.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are being used.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always ensure that documentation supports the use of any modifiers applied.
CPT code 35190, 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 35190 can also vary based on the local coverage determinations made by the Medicare Administrative Contractors (MACs). MACs are responsible for processing Medicare claims and have the authority to establish specific coverage policies that can affect whether a particular service is reimbursed in their jurisdiction.
Therefore, healthcare providers should consult both the MPFS and the relevant MAC guidelines to ascertain the reimbursement status and requirements for CPT code 35190. This ensures compliance with Medicare's billing policies and maximizes the likelihood of successful reimbursement.
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