CPT code 12046 is for intermediate repair of non-hands/feet or genitalia, covering wound lengths between 20.1 to 30 cm.
CPT code 12046 is used for the intermediate repair of wounds on areas such as the neck, hands, feet, or genitalia, where the wound length ranges from 20.1 to 30 centimeters. This code indicates that the procedure involves more than just 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 12046, which pertains to intermediate repair of non-heavily contaminated wounds of the neck, hands, feet, and/or genitalia measuring 20.1 to 30.0 cm, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure 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: Use this modifier if an evaluation and management (E/M) service was performed on the same day as the procedure and was significant and separately identifiable from the procedure.
3. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure was repeated by the same physician or other qualified healthcare professional.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the procedure was repeated by a different physician or other qualified healthcare professional.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier 99 - Multiple Modifiers: Use this modifier if more than four modifiers are necessary to describe the service.
These modifiers help provide additional information about the circumstances under which the procedure was performed and ensure accurate billing and reimbursement.
The CPT code 12046 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 12046. To determine the exact reimbursement rate, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining local coverage decisions. Each MAC may have specific guidelines and policies that can influence the reimbursement for CPT code 12046. Therefore, it is essential for healthcare providers to consult their respective MAC for the most accurate and up-to-date information regarding reimbursement for this code.
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