CPT code 12017 is for the repair of facial, ears, eyelids, nose, or lips lacerations measuring 20.1 to 30.0 cm.
CPT code 12017 is used to describe the repair of superficial wounds on the face, ears, eyelids, nose, lips, or mucous membranes that are between 20.1 and 30.0 centimeters in length. This code is typically used in medical billing to indicate the specific type and extent of wound repair performed by a healthcare provider.
For CPT code 12017, which pertains to the repair of a specific anatomical area with a length of 20.1 to 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. This could be due to the complexity of the repair or additional time and effort needed.
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 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.
4. Modifier -59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. 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 subsequent to the original procedure.
6. 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.
7. 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 related procedure is performed during the postoperative period of the initial procedure.
8. Modifier -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period of the initial procedure.
9. Modifier -80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure.
10. Modifier -81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required for the procedure.
11. Modifier -82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
12. Modifier -99 (Multiple Modifiers): Indicates that multiple modifiers are applicable to the procedure. This is 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 12017 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides the payment rates for services covered by Medicare, and the reimbursement for CPT code 12017 will depend on various factors such as geographic location and the specific Medicare Administrative Contractor (MAC) overseeing the claims in that region.
It is essential to consult the MPFS and the relevant MAC guidelines to determine the exact reimbursement rate and any additional requirements for CPT code 12017.
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