CPT code 35246 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35246 is used to describe the surgical procedure for repairing a lesion in a blood vessel. This code is specifically applied when a healthcare provider performs a repair on a blood vessel that has been damaged or has developed an abnormality, such as an aneurysm or a tear. The procedure involves techniques to restore the integrity and function of the affected vessel, ensuring proper blood flow and preventing potential complications. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, as it helps in identifying the specific service provided to the patient.
For CPT code 35246, which pertains to the repair of a blood vessel lesion, the following modifiers may be applicable:
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 or Service by Same Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by a different provider.
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 performed during the postoperative period is unrelated to the original procedure.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: 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): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 35246 is subject to reimbursement considerations under Medicare, but whether it is reimbursed 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 by Medicare, and each MAC may have additional local coverage determinations that affect reimbursement.
Therefore, to determine if CPT code 35246 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and check with their regional MAC for any specific coverage policies or requirements.
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