CPT code 12053 is for intermediate repair of the face or mucous membrane, measuring 5.1 to 7.5 cm.
CPT code 12053 is used for intermediate repair of wounds on the face, ears, eyelids, nose, lips, or mucous membranes that are between 5.1 to 7.5 centimeters in length. This code indicates that the procedure involves layered closure of one or more of these areas, typically requiring more than just a simple suture due to the complexity or depth of the wound.
For CPT code 12053, which pertains to intermediate repair of the face, ears, eyelids, nose, lips, and/or mucous membranes for wounds measuring 5.1 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 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 or Other Qualified Health Care Professional: Used when a procedure or service is repeated by the same provider.
8. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when a procedure or service is repeated by a different provider.
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 complications requiring a return to the operating room.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used for procedures or services that are unrelated to the original procedure.
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 AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these professionals assist in surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 12053, which involves intermediate repair of the face, ears, eyelids, nose, lips, and/or mucous membranes measuring 5.1 to 7.5 cm, is reimbursed by Medicare. Reimbursement for this CPT code is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the specific reimbursement amount can vary depending on the region, as it is subject to adjustments by the Medicare Administrative Contractor (MAC) responsible for the geographic area where the service is provided. Healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date reimbursement information for CPT code 12053.
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