CPT CODES

CPT Code 35820

CPT code 35820 is used for procedures involving the exploration of chest vessels to diagnose or treat vascular conditions.

Table of Contents
What is CPT Code 35820
Does CPT 35820 Need a Modifier?
CPT Code 35820 Medicare Reimbursement
Are You Being Underpaid for 35820 CPT Code?
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What is CPT Code 35820

CPT code 35820 is used to describe the surgical procedure of exploring the blood vessels in the chest. This code is typically utilized when a healthcare provider needs to investigate potential issues within the chest's vascular system, such as blockages, abnormalities, or injuries. The exploration may involve examining the arteries and veins to assess their condition and determine the appropriate course of treatment. This procedure is crucial for diagnosing and addressing various cardiovascular conditions that may affect the chest area.

Does CPT 35820 Need a Modifier?

For CPT code 35820, which involves the exploration of chest vessels, 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 it.

2. Modifier 51 - Multiple Procedures: This is used 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: This is applicable when two surgeons work together as primary surgeons performing distinct parts of a procedure. Each surgeon should report their distinct operative work.

5. Modifier 66 - Surgical Team: This modifier is used when a team of surgeons is required to perform a complex procedure. It indicates that the procedure necessitated the skills of more than one surgeon.

6. 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 a return to the operating room for a related procedure during the postoperative period of the initial surgery.

7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a procedure performed during the postoperative period is unrelated to the original procedure.

Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association and payer-specific policies. Proper documentation is crucial to justify the use of any modifier.

CPT Code 35820 Medicare Reimbursement

CPT code 35820, which involves the exploration of chest vessels, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining 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, and it is updated annually to reflect changes in policy and practice.

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 35820 is reimbursed. These determinations can vary based on geographic location and specific medical necessity criteria.

Therefore, while CPT code 35820 is generally included in the MPFS, healthcare providers should verify with their respective MAC to ensure compliance with any local policies or requirements that may impact reimbursement.

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