CPT code 35905 is used for the surgical removal of a graft from the chest area, aiding in standardized medical procedure documentation.
CPT code 35905 is used to describe the surgical procedure of excising, or removing, a graft from the thorax, which is the chest area. This code is specifically utilized when a surgeon needs to remove a previously placed graft due to complications such as infection, rejection, or other medical reasons. The procedure involves careful surgical techniques to ensure the safe removal of the graft while minimizing damage to surrounding tissues. This code is essential for accurate billing and documentation in the healthcare revenue cycle, ensuring that the healthcare provider is reimbursed appropriately for the complex surgical service provided.
For the CPT code 35905, "Excision graft thorax," the following modifiers may be applicable depending on the specific circumstances of the procedure and the billing requirements:
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. It is used to prevent bundling of services that are typically considered inclusive.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the same procedure is repeated by the same provider on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider on the same day.
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 modifier is used when a patient must return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier when a procedure is performed during the postoperative period of another procedure, but it is unrelated to the original procedure.
8. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required for the procedure.
9. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimal assistant surgeon is required for the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
11. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided accurately.
Each modifier should be used in accordance with payer guidelines and supported by appropriate documentation in the patient's medical record. Proper use of modifiers can ensure accurate billing and reimbursement for the services provided.
CPT code 35905, which involves excision procedures, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource in determining whether a specific CPT code like 35905 is reimbursable. The MPFS provides a comprehensive list of services covered by Medicare and the associated payment rates.
However, the final determination of reimbursement for CPT code 35905 also depends on the local coverage decisions made by Medicare Administrative Contractors (MACs). MACs are responsible for processing Medicare claims and have the authority to establish specific coverage policies based on regional needs and medical necessity. Therefore, while CPT code 35905 may be listed in the MPFS, healthcare providers should verify with their respective MAC to ensure compliance with any local coverage determinations that might affect reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 35905, RevFind provides unparalleled accuracy in identifying discrepancies by individual payer. Schedule a demo today to see how RevFind can enhance your revenue cycle management and secure your financial health.
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
