CPT code 12036 is for intermediate repair of superficial wounds on the scalp, arms, or trunk, measuring 20.1 to 30 cm.
CPT code 12036 is used for intermediate repair of superficial wounds of the scalp, arms, trunk, and/or extremities that are between 20.1 to 30 centimeters in length. This code is specifically for procedures that involve layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin closure. This type of repair is more complex than a simple repair and typically requires more skill and time.
For CPT code 12036, which pertains to intermediate repair of wounds of the scalp, arms, and/or trunk that are 20.1 to 30.0 cm in length, 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 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 surgical session.
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 physician or other qualified healthcare professional.
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.
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.
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.
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.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 12036 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various healthcare services, and it is updated annually.
To verify if CPT code 12036 is reimbursed, you should:
1. Check the MPFS: Access the latest version of the MPFS to see if CPT code 12036 is listed and to review the associated reimbursement rates.
2. Consult Your MAC: Each MAC may have specific guidelines and policies regarding the reimbursement of certain CPT codes. Your MAC's website or customer service can provide detailed information on whether CPT code 12036 is covered and any specific documentation or billing requirements.
By following these steps, you can determine if CPT code 12036 is reimbursed by Medicare and ensure compliance with all relevant billing guidelines.
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