CPT code 35266 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35266 is used to describe the surgical procedure for repairing a blood vessel lesion in the lower extremity. This code is specifically applied when a surgeon performs a direct repair of a blood vessel that has been damaged or has a lesion, such as an aneurysm or a tear, in the lower part of the body, including the legs. The procedure involves techniques to restore the integrity and function of the affected blood vessel, ensuring proper blood flow and reducing the risk of complications. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, as it helps healthcare providers receive appropriate reimbursement for the specialized surgical services rendered.
For CPT code 35266, which involves 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. 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 indicates 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 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 applicable.
5. Modifier 66 - Surgical Team: This modifier is used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This is 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: This 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 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 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 for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This 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 is used when an assistant surgeon is necessary due to the unavailability of a qualified resident.
13. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier is used to indicate that multiple modifiers apply.
Each modifier should be used in accordance with the specific circumstances of the procedure and payer guidelines to ensure accurate billing and reimbursement.
CPT code 35266 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the reimbursement rates for services covered under Medicare Part B, including those associated with CPT codes. To determine if CPT code 35266 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the corresponding payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a specific CPT code, such as 35266, is reimbursed in their jurisdiction. Providers should check with their respective MAC to ensure that CPT code 35266 is covered and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 35266 can be reimbursed by Medicare, providers must verify its status on the MPFS and consult their MAC for any local coverage policies that might impact reimbursement.
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