CPT code 13120 is for complex repair of superficial wounds on the scalp, arms, and legs, measuring 1.1 to 2.5 cm.
CPT code 13120 is used for a complex repair of a wound on the scalp, arms, or legs that measures between 1.1 to 2.5 centimeters. This code indicates that the procedure involves more than just 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. This type of repair is typically more intricate due to the nature of the wound and the need for precise suturing to ensure proper healing and minimal scarring.
For CPT code 13120, which pertains to complex repair of the scalp, arms, and/or legs for a length of 1.1 to 2.5 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 50 - Bilateral Procedure: Used when the procedure is performed on both sides of the body.
4. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
5. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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 when a patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same provider during the postoperative period.
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 during the procedure.
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 non-physician providers assist in surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 13120, which involves a complex 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 services covered by Medicare. Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC) as they can provide region-specific guidance and any additional requirements or documentation needed for reimbursement.
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