CPT code 12042 is for intermediate repair of non-face/genital wounds measuring 2.6-7.5 cm.
CPT code 12042 is used for an intermediate repair of a wound on the non-head, neck, or genital area that measures between 2.6 to 7.5 centimeters. This code is typically utilized when the wound requires layered closure, meaning the repair involves closing one or more of the deeper layers of tissue before closing the skin. This type of repair is more complex than a simple repair but less complex than a complex repair.
For CPT code 12042, which pertains to intermediate repair of wounds on the neck, hands, feet, and/or external genitalia measuring 2.6 to 7.5 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.
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 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 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 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used for a planned or anticipated procedure during the postoperative period.
6. 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.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician.
9. 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 for an unplanned return to the operating room for a related procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used for an unrelated procedure during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required.
13. 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.
14. 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.
The CPT code 12042 is reimbursed by Medicare, but the specifics of reimbursement can vary based on several factors. To determine if this code is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and can provide region-specific information regarding the reimbursement of CPT code 12042. It is advisable for healthcare providers to verify with their respective MAC to ensure accurate and up-to-date information on reimbursement policies.
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