CPT code 12051 is for intermediate repair of the face, ears, eyelids, nose, lips, or mucous membranes for wounds 2.5 cm or less.
CPT code 12051 is used for intermediate repair of wounds on the face, ears, eyelids, nose, lips, or mucous membranes that are 2.5 centimeters or less in length. This code indicates that the repair involves layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin (epidermal and dermal) closure. This type of repair is more complex than a simple repair and is typically required for wounds that are deeper or have jagged edges.
For CPT code 12051, which pertains to intermediate repair of the face, ears, eyelids, nose, lips, and/or mucous membranes for wounds 2.5 cm or less, 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 of the initial procedure.
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 AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 12051, which pertains to intermediate repair of the face, ears, eyelids, nose, or lips with a wound size of 2.5 cm or less, is generally reimbursed by Medicare. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. However, the final determination of reimbursement can also depend on the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) for your region. It is advisable to consult the MPFS and your local MAC to confirm the reimbursement status and any specific documentation requirements for CPT code 12051.
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