CPT code 12011 is for the repair of superficial wounds on the face, ears, eyelids, nose, lips, or mouth that are 2.5 cm or less.
CPT code 12011 is used for the repair of superficial wounds on the face, ears, eyelids, nose, lips, or mucous membranes that are 2.5 centimeters or less in length. This code specifically refers to simple repair procedures, which typically involve suturing the wound to promote healing and minimize scarring.
When using CPT code 12011, which pertains to a specific type of repair, the following modifiers may be applicable:
1. Modifier -22 (Increased Procedural Services)
- Use this modifier if the service provided is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
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 a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
3. Modifier -51 (Multiple Procedures)
- Use this modifier when multiple procedures are performed at the same session by the same provider. This indicates that the procedure is one of several performed.
4. Modifier -52 (Reduced Services)
- This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier -59 (Distinct Procedural Service)
- Apply this modifier 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/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier -76 (Repeat Procedure or Service by Same Physician)
- Use this modifier to indicate that a procedure or service was repeated by the same physician subsequent to the original procedure or service.
7. Modifier -77 (Repeat Procedure by Another Physician)
- This modifier is used when a procedure or service is repeated by another physician subsequent to the original procedure or service.
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 or service 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 for the procedure.
11. Modifier -81 (Minimum Assistant Surgeon)
- Apply this modifier when a minimum assistant surgeon is required for the procedure.
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 two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used according to the guidelines provided by the CPT coding manual and payer-specific requirements. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
The CPT code 12011 is reimbursed by Medicare, but the reimbursement rate can vary based on several factors. To determine the specific reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare. Additionally, Medicare Administrative Contractors (MACs) may have localized adjustments or guidelines that can affect reimbursement. It is essential for providers to consult both the MPFS and their respective MAC to get accurate and up-to-date information on the reimbursement for CPT code 12011.
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