CPT code 35276 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35276 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 to address issues such as tears, blockages, or other abnormalities that may be affecting the vessel's function. The procedure aims to restore normal blood flow and prevent complications that could arise from the damaged vessel. This code is crucial for accurate billing and documentation in the healthcare revenue cycle, ensuring that the provider is reimbursed appropriately for the surgical intervention performed.
When considering the use of modifiers for CPT code 35276, which pertains to the repair of a blood vessel lesion, it is important to understand the context of the procedure and any specific circumstances that may require the application of modifiers. Here is a list of potential modifiers that could be used with this CPT code, along with the reasons for their use:
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 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: This modifier is used when a 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 is used when a patient requires an unplanned 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 for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance during 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 surgeon is not available.
13. Modifier 99 - Multiple Modifiers: When more than four modifiers are necessary to describe the service, this modifier indicates that multiple modifiers are being used.
Each of these modifiers serves a specific purpose and should be applied based on the individual circumstances of the procedure. Proper use of modifiers is crucial for accurate billing and reimbursement in healthcare revenue cycle management.
CPT code 35276 is subject to reimbursement by 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 under Medicare Part B, and each MAC may have additional local coverage determinations that affect reimbursement.
Therefore, healthcare providers should verify the reimbursement status of CPT code 35276 by consulting the MPFS and the relevant MAC policies to ensure compliance and proper billing practices.
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