CPT code 12052 is for intermediate repair of the face or mucous membrane, measuring 2.6 to 5.0 cm.
CPT code 12052 is used for an intermediate repair of wounds on the face, ears, eyelids, nose, lips, or mucous membranes that are between 2.6 to 5.0 centimeters in length. This type of repair involves layered closure of one or more of the deeper layers of subcutaneous tissue and superficial fascia, in addition to the skin closure.
For CPT code 12052, which pertains to intermediate repair of the face, ears, eyelids, nose, lips, and/or mucous membranes for wounds 2.6 to 5.0 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. Documentation must support the substantial additional work and the reason for it.
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 is distinct from the procedure itself.
3. Modifier 51 - Multiple Procedures: Use this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider. This indicates that the procedure is one of several performed.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
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. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure had to be repeated by the same provider subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the procedure had to be repeated by a different provider subsequent to the original procedure.
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: Use this modifier if the patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the procedure performed during the postoperative period was unrelated to the original procedure.
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 AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when these non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for services rendered.
The CPT code 12052, which involves intermediate repair of the face, ears, eyelids, nose, or lips for wounds measuring 2.6 to 5.0 cm, is reimbursed by Medicare. Reimbursement rates for this code can be found in the Medicare Physician Fee Schedule (MPFS), which outlines the payment amounts for various medical services covered by Medicare.
Additionally, the specific reimbursement amount may vary slightly depending on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local payment rates. Therefore, it is advisable to consult the MPFS and your local MAC for the most accurate and up-to-date reimbursement information for CPT code 12052.
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