CPT code 35286 is used for procedures involving the repair of a blood vessel lesion, ensuring accurate documentation and reimbursement.
CPT code 35286 is used to describe the surgical procedure for repairing a lesion in a blood vessel. This code is typically utilized 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 blood vessel, ensuring proper blood flow and reducing the risk of complications. This code is essential for accurate billing and documentation in the healthcare revenue cycle, as it helps ensure that the provider is reimbursed appropriately for the specialized surgical services rendered.
When dealing with CPT code 35286 for the repair of a blood vessel lesion, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers and their reasons for use:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more effort or time than typically expected. Documentation must support the increased complexity.
2. Modifier 51 (Multiple Procedures): Apply this modifier 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): This modifier is used to indicate that the procedure is 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): If two surgeons are required to perform the procedure due to its complexity, this modifier should be used to indicate that both surgeons are equally responsible for the procedure.
5. Modifier 66 (Surgical Team): Use this modifier when the procedure requires a surgical team due to its complexity, indicating that multiple professionals are involved.
6. Modifier 76 (Repeat Procedure by Same Physician): This modifier is applicable if 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): If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier is appropriate.
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): If an assistant surgeon is necessary for the procedure, this modifier should be applied.
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 modifier is used when an assistant surgeon is necessary, and 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 crucial to justify the use of any modifier.
CPT code 35286 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in establishing the reimbursement rates for services covered under Medicare Part B, including those associated with CPT codes. To determine if CPT code 35286 is reimbursed, healthcare providers should consult the MPFS to verify if the code is listed and to understand the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing claims and making coverage determinations at the regional level. Each MAC may have specific Local Coverage Determinations (LCDs) that can affect whether CPT code 35286 is reimbursed in a particular jurisdiction. Providers should review the LCDs issued by their respective MAC to ensure compliance with any regional guidelines or requirements that may impact reimbursement for this specific code.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 35286, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
