CPT code 12007 is for the repair of superficial wounds on the scalp, neck, axillae, external genitalia, trunk, and/or extremities longer than 30.0 cm.
CPT code 12007 is used for reporting the repair of superficial wounds on the scalp, neck, axillae (armpits), external genitalia, trunk, and/or extremities (including hands and feet) when the total length of the wound(s) is greater than 30.0 centimeters. This code is typically used by healthcare providers to document and bill for the closure of extensive superficial wounds that require more than simple suturing due to their size.
For CPT code 12007, which pertains to the repair of superficial wounds of the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet) when the wound is greater than 30.0 cm, 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.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Used when an evaluation and management (E/M) service is performed on the same day as the procedure.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same session by the same provider.
4. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Used when a subsequent procedure is planned or staged during the postoperative period of the initial procedure.
6. 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.
7. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by the same provider.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by a different provider.
9. 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
13. 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.
14. 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 12007, which refers to a specific medical procedure, is reimbursed by Medicare, but the reimbursement amount can vary. To determine the exact reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various CPT codes, including 12007. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) as they can provide region-specific information and any additional guidelines or requirements that may affect reimbursement for CPT code 12007.
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