CPT code 40652 is used for billing the repair of the lip, detailing the specific procedure performed for accurate healthcare reimbursement.
CPT code 40652 is used to describe the surgical procedure for repairing a defect or injury to the lip. This code specifically indicates that the repair is performed on the lip tissue, which may involve suturing or reconstructing the area to restore its normal appearance and function. This procedure is typically necessary for patients who have experienced trauma, congenital defects, or other conditions affecting the lip.
For CPT code 40652 (Repair lip), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the repair of the lip required significantly more work than typically required. This could be due to the complexity of the repair or the patient's condition.
2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was 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: Use this modifier if the repair is part of a staged or related procedure during the postoperative period of the initial surgery.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the repair of the lip was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same physician performed the repair of the lip more than once on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if a different physician performed the repair of the lip more than once on the same day.
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: Use this modifier if the patient required an unplanned return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if the repair of the lip is unrelated to the original procedure performed during the postoperative period.
9. Modifier 80 - Assistant Surgeon: Apply this modifier if an assistant surgeon was necessary for the repair of the lip.
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 if an assistant surgeon was necessary because a qualified resident surgeon was not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Apply this modifier if a PA, NP, or CNS assisted in the surgery.
13. Modifier LT - Left Side: Use this modifier if the repair was performed on the left side of the lip.
14. Modifier RT - Right Side: Apply this modifier if the repair was performed on the right side of the lip.
15. Modifier 99 - Multiple Modifiers: Use this modifier if more than four modifiers are required to describe the service.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
CPT code 40652 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), which means it is eligible for payment under Medicare Part B. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's important to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
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