CPT code 40812 is used for the excision or repair of a lesion in the mouth, helping healthcare providers bill for specific procedures.
CPT code 40812 is used to describe the procedure of excising or repairing a lesion located in the mouth. This code specifically pertains to surgical interventions aimed at removing or correcting abnormal tissue growths or lesions within the oral cavity, which may include areas such as the gums, tongue, or inner cheeks. The procedure is typically performed to address issues such as tumors, cysts, or other pathological conditions affecting oral health.
For CPT code 40812 (Excise/repair mouth lesion), 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 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the mouth.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. 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.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
8. 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.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
12. 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.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these healthcare professionals assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 40812, which involves excision or repair, is reimbursed by Medicare, but the specifics of reimbursement can vary. To determine if CPT 40812 is covered and the extent of reimbursement, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for region-specific guidelines and policies. MACs are responsible for processing Medicare claims and can provide further clarification on coverage, documentation requirements, and any potential limitations or conditions for reimbursement of CPT code 40812.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 40812. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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