CPT code 13151 is for complex repair of the face, ears, eyelids, nose, or lips, measuring 1.1 to 2.5 cm.
CPT code 13151 is used for a complex repair of the face, ears, eyelids, nose, or lips involving a wound that is between 1.1 to 2.5 centimeters in length. This code is specifically for procedures that require more than a simple or intermediate repair due to the intricacy of the location and the need for layered closure, which may involve extensive undermining, debridement, or meticulous alignment of tissue.
For CPT code 13151, which pertains to complex repair of the face, ears, eyelids, nose, or lips for a wound size of 1.1 to 2.5 cm, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure 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 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could occur if the full extent of the procedure was not necessary or could not be completed.
3. 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.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It 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: Use this modifier if the same procedure was repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Apply this modifier if the same procedure was repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
7. 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 if the patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon: Apply this modifier if an assistant surgeon was required to help perform the procedure.
10. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is 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: Apply this modifier if 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 13151 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare and can be accessed online for the most current information.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have specific guidelines and rates for different localities. Therefore, it is advisable to consult the relevant MAC for your area to ensure accurate and up-to-date reimbursement information for CPT code 13151.
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