CPT code 35216 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35216 is used to describe the surgical procedure for repairing a blood vessel lesion in the neck. This code is specifically applied when a surgeon performs a direct repair on 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 vessel, identifying the lesion, and then repairing it to restore normal blood flow and function. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that the healthcare provider is reimbursed appropriately for the specialized surgical service provided.
When dealing with CPT code 35216, 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: 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: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was 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 a surgical team.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician repeats the procedure on the same day, this modifier is used to indicate the repetition.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure is repeated by a different physician on the same day.
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 returns 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 is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier 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 because a qualified resident surgeon is not available.
These modifiers help provide additional context and detail about the procedure, ensuring accurate billing and reimbursement. It is important to review the specific circumstances of each case to determine the appropriate modifiers to apply.
The CPT code 35216 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates.
However, the actual reimbursement for CPT code 35216 can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a particular region. Each MAC may have specific local coverage determinations (LCDs) that further define the circumstances under which CPT code 35216 is reimbursable.
Therefore, healthcare providers should consult their respective MAC for detailed information on coverage and reimbursement for this specific code.
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