CPT code 12035 is for intermediate repair of superficial wounds on the scalp, arms, trunk, etc., measuring 12.6 to 20 cm.
CPT code 12035 is used for intermediate repair of superficial wounds of the scalp, arms, trunk, and/or extremities that are between 12.6 to 20 centimeters in length. This code indicates that the procedure involves layered closure of one or more of these wounds, which typically requires more than a simple one-layer closure but is less complex than a complex repair.
For CPT code 12035, which pertains to intermediate repair of wounds of the scalp, arms, trunk, and/or extremities measuring 12.6 to 20 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 -59 (Distinct Procedural Service)
- Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
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 provider.
7. 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.
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 patient returns to the operating room for a related procedure during the postoperative period.
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 provider during the postoperative period.
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 circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 12035, which refers to intermediate repair of superficial wounds of the scalp, axillae, trunk, and/or extremities measuring 12.6 to 20 cm, is reimbursed by Medicare. Reimbursement is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the specific reimbursement rate and coverage details can vary depending on the region, as they are managed by the respective Medicare Administrative Contractor (MAC) for that area. It is advisable to consult the MPFS and your local MAC for precise reimbursement information and any potential coverage limitations.
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