CPT code 12004 is for the repair of superficial wounds on the scalp, neck, axillae, external genitalia, trunk, and/or extremities measuring 7.6-12.5 cm.
CPT code 12004 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 7.6 to 12.5 centimeters. This code is specifically for simple repair procedures, which typically involve suturing the wound without the need for extensive cleaning or removal of foreign material.
When using CPT code 12004, which pertains to the repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet) measuring 7.6 to 12.5 cm, the following modifiers may be applicable:
1. Modifier -22 (Increased Procedural Services)
- Use this modifier if the procedure required significantly greater effort than typically required. This could be due to complications or unusual circumstances.
2. Modifier -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service)
- Apply this modifier if an evaluation and management (E/M) service was performed on the same day as the procedure and was distinct and separately identifiable from the procedure itself.
3. Modifier -51 (Multiple Procedures)
- Use this modifier when multiple procedures are performed during the same session. This indicates that the procedure is one of several performed.
4. Modifier -52 (Reduced Services)
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. 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. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. 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 physician or other qualified healthcare professional.
7. 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 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)
- Apply this modifier if the 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)
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier -80 (Assistant Surgeon)
- This modifier is used when an assistant surgeon is required during the procedure.
11. Modifier -81 (Minimum Assistant Surgeon)
- Apply this modifier when a minimum assistant surgeon is required.
12. Modifier -82 (Assistant Surgeon (when qualified resident surgeon not available))
- Use this modifier when an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier -99 (Multiple Modifiers)
- This modifier is used when multiple modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Always refer to the latest CPT and payer guidelines to confirm the correct usage of modifiers.
When considering the reimbursement of CPT code 12004 by Medicare, it is essential to refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
CPT code 12004 is included in the MPFS, which means it is eligible for reimbursement by Medicare. However, the actual reimbursement amount can vary based on several factors, including geographic location and the specific Medicare Administrative Contractor (MAC) overseeing the claims in that region. Each MAC may have slightly different policies and rates, so it is crucial to verify the specific details with the MAC that services your area.
In summary, CPT code 12004 is reimbursed by Medicare as per the Medicare Physician Fee Schedule, but the exact reimbursement details should be confirmed with the relevant Medicare Administrative Contractor.
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