CPT code 12034 is for intermediate repair of superficial wounds on the scalp, trunk, or extremities, measuring 7.6 to 12.5 cm.
CPT code 12034 is used for an intermediate repair of superficial wounds on the scalp, neck, arms, or legs that are between 7.6 to 12.5 centimeters in length. This code indicates that the procedure involves more than a simple closure, requiring layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin.
For CPT code 12034, which pertains to intermediate repair of wounds of the scalp, axillae, trunk, and/or extremities (excluding hands and feet) measuring 7.6 cm to 12.5 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 complications or other factors that increase the complexity of the procedure.
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 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 -52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. 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 physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier -77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Used when a procedure or service is repeated by another physician or other qualified healthcare professional 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): Used when a related procedure is performed during the postoperative period of the initial procedure.
9. 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 of the initial procedure.
10. Modifier -80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
11. Modifier -81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required during the procedure.
12. 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.
13. 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 performed procedure, ensuring accurate billing and reimbursement.
CPT code 12034, which pertains to a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare. Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for any region-specific guidelines or variations in reimbursement policies. The MAC is responsible for processing Medicare claims and can provide detailed information on coverage and payment for CPT code 12034.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 12034. Don't let underpayments slip through the cracks—schedule a demo today and see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
