CPT code 12021 is for the closure of a split wound, detailing the medical procedure for billing and documentation purposes.
CPT code 12021 is used to describe the procedure for the closure of a split wound. This code specifically refers to the repair of a wound that has been split open, typically requiring sutures, staples, or adhesive strips to close the wound properly. The procedure ensures that the wound heals correctly and minimizes the risk of infection or further complications.
For CPT code 12021, "Closure of split wound," 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 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used when an evaluation and management service provided during a postoperative period is unrelated to the original procedure.
3. 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 a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the procedure.
4. Modifier 32 - Mandated Services: Used when services are required by a third party, such as an insurance company or government agency.
5. Modifier 47 - Anesthesia by Surgeon: Used when the surgeon provides regional or general anesthesia for the procedure.
6. Modifier 50 - Bilateral Procedure: Used when the same procedure is performed on both sides of the body.
7. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session by the same provider.
8. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
9. Modifier 53 - Discontinued Procedure: Used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
10. Modifier 54 - Surgical Care Only: Used when only the surgical care portion of a service is provided.
11. Modifier 55 - Postoperative Management Only: Used when only the postoperative management portion of the care is provided.
12. Modifier 56 - Preoperative Management Only: Used when only the preoperative care portion of the service is provided.
13. Modifier 57 - Decision for Surgery: Used when an evaluation and management service results in the initial decision to perform surgery.
14. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service during the postoperative period was planned or anticipated.
15. 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.
16. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
17. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician.
18. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician.
19. 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.
20. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
21. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
22. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
23. 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.
24. 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 12021 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, the reimbursement for CPT code 12021 may vary depending on the local policies set by the Medicare Administrative Contractor (MAC) for the region where the service is provided. It is essential for healthcare providers to consult both the MPFS and their respective MAC guidelines to ensure accurate billing and reimbursement for this code.
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