CPT code 35271 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35271 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 direct repair of 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 reducing the risk of complications. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, as it helps ensure that the provider is reimbursed appropriately for the specialized surgical service rendered.
For CPT code 35271, 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 work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 59 (Distinct Procedural Service): Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, this modifier indicates that both surgeons are primary and each is performing a distinct part of the procedure.
5. Modifier 66 (Surgical Team): Use this modifier when a team of surgeons is necessary to perform the procedure due to its complexity.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same physician needs to repeat the procedure on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): Use this when a different physician repeats the procedure 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 if the patient needs to 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): Apply this modifier when the procedure is unrelated to the original procedure and occurs during the postoperative period.
10. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required to help with the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Use this 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 because a qualified resident is not available.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper documentation is essential to justify the use of any modifier.
CPT code 35271, 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 to Medicare beneficiaries.
However, the reimbursement for CPT code 35271 can also vary based on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region. MACs are private organizations contracted by Medicare to process claims and determine coverage specifics, including local coverage determinations (LCDs) that may affect the reimbursement of certain procedures. Therefore, while CPT code 35271 is generally reimbursable under Medicare, it is essential for healthcare providers to verify the specific coverage details and reimbursement rates with their respective MAC to ensure compliance and accurate billing.
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