CPT code 13102 is for complex repair of the trunk for each additional 5 cm or less.
CPT code 13102 is used to describe a complex repair of the trunk for each additional 5 centimeters or less. This code is typically used when a healthcare provider performs a complex surgical repair on the trunk area, such as the chest or abdomen, and the repair extends beyond the initial 5 centimeters covered by the primary code. It is an add-on code, meaning it should be used in conjunction with the primary code that describes the initial portion of the repair.
For CPT code 13102, which pertains to complex repair procedures, 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 factors such as increased intensity, time, technical difficulty, severity of the patient's condition, or physical and mental effort required.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed on the same day.
3. 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 modifier is essential when procedures are not typically reported together but are appropriate under the circumstances.
4. Modifier 76 (Repeat Procedure by Same Physician): Applied when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 (Repeat Procedure by Another Physician): Used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when a procedure or service performed during the postoperative period is unrelated to the original procedure.
8. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
9. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required during the procedure.
10. 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.
11. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Applied when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used according to the guidelines to ensure accurate billing and reimbursement.
When considering whether CPT code 13102 is reimbursed by Medicare, it is essential to refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
To determine if CPT code 13102 is reimbursed, healthcare providers should consult the MPFS database. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing Medicare policies at the regional level. MACs may have specific guidelines or local coverage determinations (LCDs) that affect the reimbursement of CPT code 13102.
In summary, CPT code 13102 is reimbursed by Medicare if it is listed in the MPFS and adheres to any additional guidelines or LCDs set forth by the respective MAC. Healthcare providers should verify the specific details through the MPFS and consult their MAC for any regional variations or additional requirements.
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