CPT code 13131 is used for complex repair of the face, chin, cheek, mouth, neck, axillae, genitalia, hands, or feet.
CPT code 13131 is used for a complex repair of wounds on the face, ears, eyelids, nose, lips, and/or mucous membranes. This code specifically refers to procedures that involve layered closure of wounds, which may include extensive undermining, placement of retention sutures, or other techniques to repair deeper structures such as nerves, blood vessels, and tendons. This type of repair is more intricate than a simple or intermediate repair and is typically required for wounds that are more severe or located in cosmetically sensitive areas.
For CPT code 13131, which pertains to complex repair of the face, ears, eyelids, nose, lips, and/or mucous membranes, 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 increased complexity or difficulty of the repair.
2. Modifier 52 (Reduced Services): Applied when a service or procedure is partially reduced or eliminated at the physician's discretion.
3. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Used if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
4. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. 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 physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Applied when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period): Used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial procedure.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.
9. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required for the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is required because a qualified resident surgeon is not available.
12. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): Indicates that a physician assistant, nurse practitioner, or clinical nurse specialist provided services as an assistant at surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 13131 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 13131.
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