CPT code 13152 is for complex repair of the face, ears, eyelids, nose, or lips, measuring 2.6 to 7.5 cm.
CPT code 13152 is used to describe a complex repair procedure on the face, ears, eyelids, nose, or lips, specifically for wounds that are between 2.6 to 7.5 centimeters in length. This code indicates that the repair involves more intricate techniques than a simple or intermediate repair, often requiring layered closure, debridement, or extensive undermining to achieve optimal healing and cosmetic results.
For CPT code 13152, which pertains to complex repair of the face, ears, eyelids, nose, or lips with a length of 2.6 to 7.5 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. This could be due to factors such as increased complexity or time.
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 prospectively or at the time of the original procedure, or if it was more extensive than the original 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 qualified healthcare professional subsequent to the original procedure or service.
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): 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 an unrelated procedure or service was performed by the same physician during the postoperative period.
9. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Applied when an assistant surgeon provides minimal assistance during the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary 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 assistance during surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 13152 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect reimbursement for CPT code 13152. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies specific to your geographic area.
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