CPT code 35231 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35231 is used to describe the surgical procedure for repairing a blood vessel lesion. This code is specifically applied when a surgeon performs a direct repair of a blood vessel that has been damaged or has developed an abnormal lesion, which could be due to trauma, disease, or other medical conditions. The procedure involves restoring the integrity and function of the affected blood vessel to ensure proper blood flow and prevent complications. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the specialized surgical services they deliver.
For CPT code 35231, which pertains to the repair of a 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 procedure required significantly greater effort or complexity than typically required. This could be due to unusual patient anatomy or complications during the repair.
2. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that the repair of the blood vessel lesion was one of several procedures.
3. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is particularly relevant if the repair was performed in a different anatomical site or through a separate incision.
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 that both surgeons were actively involved.
5. Modifier 66 (Surgical Team): Use this modifier if the procedure required a surgical team due to its complexity or the patient's condition, indicating that multiple specialists were involved.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if the same physician had to repeat the procedure on the same day due to unforeseen circumstances.
7. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if a different physician had to repeat the procedure on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room): If the patient had to return to the operating room unexpectedly for a related procedure during the postoperative period, this modifier should be applied.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if the repair of the blood vessel lesion was performed during the postoperative period of another, unrelated procedure.
10. Modifier 80 (Assistant Surgeon): If an assistant surgeon was necessary for the procedure, this modifier should be used to indicate their involvement.
11. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if an assistant surgeon was required for a minimal portion of the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is applicable if an assistant surgeon was necessary due to the unavailability of a qualified resident.
These modifiers help provide additional context and ensure accurate billing and reimbursement for the procedure. It is important to document the specific circumstances justifying the use of each modifier.
CPT code 35231 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the actual reimbursement for CPT code 35231 can vary based on geographic location, as each MAC has the authority to interpret national Medicare policies and set local coverage determinations (LCDs) that may affect whether and how a particular service is reimbursed.
Therefore, healthcare providers should consult the MPFS and their specific MAC's guidelines to determine the exact reimbursement details for CPT code 35231.
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