CPT code 35261 is used to describe the procedure for repairing a lesion in a blood vessel, ensuring accurate documentation and reimbursement.
CPT code 35261 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 of a blood vessel that has been damaged or has developed an abnormality, such as an aneurysm or a tear, within the neck region. The procedure aims to restore normal blood flow and prevent complications that could arise from the lesion, such as restricted blood flow or rupture. This code is essential for accurate billing and documentation of the surgical intervention performed by healthcare providers.
For CPT code 35261, 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: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for the additional work, such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed on the same day.
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 used to identify procedures that are not normally reported together but are appropriate under the circumstances.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon should report their distinct operative work by appending modifier 62 to the procedure code.
5. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform a complex procedure. Each surgeon should report their specific role in the surgery.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by the same provider subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is 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 requires a return 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 to assist the primary surgeon during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
Each modifier should be used in accordance with the specific guidelines and documentation requirements set forth by the payer to ensure proper billing and reimbursement.
CPT code 35261, 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.
To ascertain if CPT code 35261 is reimbursed, healthcare providers should consult the MPFS for the current year to verify its inclusion and the associated reimbursement rate. Additionally, Medicare Administrative Contractors (MACs) play a pivotal role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make determinations on coverage and payment for services within their jurisdiction. They may have specific local coverage determinations (LCDs) that affect whether CPT code 35261 is reimbursed in certain regions.
Therefore, while CPT code 35261 can be reimbursed by Medicare, providers must ensure compliance with both the MPFS guidelines and any relevant MAC policies to secure reimbursement.
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