CPT code 12045 is for intermediate repair of non-hf/genital wounds measuring 12.6-20 cm.
CPT code 12045 is used to describe an intermediate repair of a wound on the non-hands and feet or genital area, specifically when the wound measures between 12.6 to 20 centimeters. This code is typically used by healthcare providers to document and bill for the procedure of closing a wound that requires layered closure, which involves repairing deeper layers of tissue before closing the skin.
For CPT code 12045, which pertains to intermediate repair of wounds, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Apply this modifier if 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
- Use this modifier when multiple procedures are performed during the same surgical session. This helps in indicating that multiple services were provided.
4. Modifier 52 - Reduced Services
- This modifier is 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
- Apply this modifier if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier 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 or Other Qualified Health Care Professional
- This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier when a procedure or service is repeated by another physician or qualified healthcare professional.
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
- Use this modifier for an unplanned return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon
- Apply this modifier when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier when a minimum assistant surgeon is required for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier 99 - Multiple Modifiers
- Use this modifier when multiple 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 12045 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. To determine the specific reimbursement rate, you would need to refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, the reimbursement can be influenced by the local policies of the Medicare Administrative Contractor (MAC) that services your region. Each MAC may have different guidelines and rates, so it is crucial to consult the MAC for your specific area to get accurate information on the reimbursement for CPT code 12045.
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