CPT code 12002 is for the repair of superficial wounds on the scalp, neck, axillae, external genitalia, trunk, and/or extremities measuring 2.6-7.5 cm.
CPT code 12002 is used for the repair of superficial wounds on the scalp, neck, axillae (armpits), external genitalia, trunk, and/or extremities (including hands and feet) when the wound length is between 2.6 to 7.5 centimeters. This code specifically applies to simple repairs, which typically involve suturing the wound edges together without the need for extensive cleaning or removal of foreign material.
For CPT code 12002, which pertains to the repair of superficial wounds, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Applied when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the procedure.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same session. This modifier indicates that the procedure is one of several performed on the same day.
4. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Applied if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
5. Modifier 59 (Distinct Procedural Service): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
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 physician or other qualified healthcare professional.
7. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Applied when the same procedure is repeated by a different physician or other qualified healthcare professional.
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): Used when a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is required, and a qualified resident surgeon is not available.
13. Modifier 99 (Multiple Modifiers): Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 12002 is reimbursed by Medicare, but it is essential to verify the specific reimbursement rate and coverage details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective payment rates.
Additionally, it is advisable to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect reimbursement for CPT code 12002. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and payment rates in your area.
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