CPT code 35211 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35211 is used to describe the surgical procedure for repairing a blood vessel lesion in the neck. This code is specifically applied when a healthcare provider performs a direct repair of a blood vessel that has been damaged or has developed a lesion, which could be due to trauma, disease, or other medical conditions. The procedure involves accessing the affected blood vessel, identifying the lesion, and then repairing it to restore normal blood flow and function. This code is essential for accurate billing and documentation in the healthcare revenue cycle, ensuring that the provider is reimbursed appropriately for the surgical intervention performed.
When dealing with CPT code 35211, which pertains to the repair of a blood vessel lesion, there are several modifiers that may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their purposes:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to unusual anatomy or complications that arose during the procedure.
2. Modifier 51 (Multiple Procedures): If multiple procedures were performed during the same surgical session, this modifier should be used to indicate that more than one procedure was carried out.
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 particularly useful if the repair of the blood vessel lesion was separate from other interventions.
4. Modifier 62 (Two Surgeons): If two surgeons were required to perform the procedure due to its complexity, this modifier should be used to indicate the collaborative effort.
5. Modifier 66 (Surgical Team): In cases where the procedure required a surgical team due to its complexity, this modifier would be appropriate.
6. Modifier 76 (Repeat Procedure by Same Physician): If the procedure needed to be repeated by the same physician, this modifier should be used to indicate the repetition.
7. Modifier 77 (Repeat Procedure by Another Physician): If the procedure was repeated by a different physician, this modifier would be applicable.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room): Use this modifier if the patient needed 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): If an unrelated procedure was performed by the same physician during the postoperative period, this modifier should be used.
10. Modifier 80 (Assistant Surgeon): If an assistant surgeon was necessary for the procedure, this modifier should be applied.
11. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if a minimum assistant surgeon was required.
12. 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.
13. Modifier 99 (Multiple Modifiers): If more than one modifier is applicable, this modifier indicates that multiple modifiers are being used.
Each of these modifiers serves a specific purpose and should be applied according to the unique circumstances of the procedure to ensure accurate billing and reimbursement. Proper use of modifiers can help avoid claim denials and ensure that the healthcare provider is adequately compensated for the services rendered.
CPT code 35211 is subject to reimbursement by Medicare, but its eligibility for payment depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
The MPFS outlines the payment rates for services covered under Medicare Part B, and each MAC may have additional local coverage determinations that influence whether a particular service is reimbursed.
Therefore, healthcare providers should verify the reimbursement status of CPT code 35211 by consulting the MPFS and the relevant MAC policies to ensure compliance and proper billing practices.
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