CPT code 13101 is for complex repair of the trunk, measuring 2.6 to 7.5 cm.
CPT code 13101 is used to describe a complex repair of the trunk, specifically for wounds that are between 2.6 to 7.5 centimeters in length. This code is utilized when 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. Complex repairs often require more intricate techniques and may involve extensive undermining, debridement, and other procedures to ensure proper healing and function.
For CPT code 13101, which pertains to complex repair of the trunk measuring 2.6 to 7.5 cm, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the complexity of the repair is significantly greater than typically required for the listed procedure.
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 E/M service was performed on the same day as the procedure and was distinct from the procedure itself.
3. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure was 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: Use this modifier if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
6. 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.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same procedure was repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure was repeated by a different physician.
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: Use this modifier if an unplanned return to the operating room was necessary.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was necessary for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was necessary for the procedure.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.
14. Modifier 99 - Multiple Modifiers: Use this modifier if more than one modifier is necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 13101, which involves a complex repair of the trunk measuring 2.6 to 7.5 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 services covered by Medicare. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) for any region-specific guidelines or adjustments that may apply to the reimbursement of CPT code 13101.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 13101. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
