CPT code 12057 is for intermediate repair of the face or mucous membrane for wounds greater than 30.0 cm.
CPT code 12057 is used for an intermediate repair of a wound on the face, ears, eyelids, nose, lips, or mucous membranes that is greater than 30.0 centimeters in length. This code indicates that the procedure involves more than 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 closure.
For CPT code 12057, which pertains to intermediate repair of the face, ears, eyelids, nose, lips, and/or mucous membranes for wounds greater than 30.0 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. This could be due to the complexity or severity of the wound.
2. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Applied when a significant, separately identifiable evaluation and management (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. This modifier 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): Applied if the procedure was planned or anticipated (staged), or if it was more extensive than the original procedure.
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. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Applied when the same procedure 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 the same procedure is repeated by a different 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): Applied when 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): Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied 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 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 12057, which pertains to intermediate repair of the face, ears, eyelids, nose, or lips for wounds greater than 30.0 cm, 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 12057. 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 the most accurate and up-to-date reimbursement information for CPT code 12057.
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