CPT code 12056 is for intermediate repair of the face or mucous membrane, covering a wound size of 20.1 to 30.0 cm.
CPT code 12056 is used for an intermediate repair of wounds on the face, ears, eyelids, nose, lips, or mucous membranes that are between 20.1 to 30.0 centimeters in length. This code indicates that the procedure involves layered closure of one or more of these areas, typically requiring more than a simple repair due to the complexity or depth of the wound.
For CPT code 12056, which pertains to intermediate repair of the face, ears, eyelids, nose, lips, and/or mucous membranes for wounds 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, other than E/M services, physical medicine and rehabilitation services, or provision of supplies (e.g., vaccines), are performed at the same session by the same provider.
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.
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 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 was repeated by another physician or other qualified healthcare professional 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 returns 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 if a physician assistant, nurse practitioner, or clinical nurse specialist provided assistance during the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 12056, which involves intermediate repair, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various CPT codes, including 12056. Additionally, reimbursement can vary slightly depending on the region, as Medicare Administrative Contractors (MACs) may have localized adjustments. Therefore, it is advisable to consult the relevant MAC for precise reimbursement details in your specific area.
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