CPT code 40814 is used to describe the excision or repair of a lesion in the mouth, helping healthcare providers bill for specific procedures.
CPT code 40814 is used to describe the procedure of excising or repairing a lesion located in the mouth. This code specifically applies 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 typically involves cutting away the affected tissue and may also include reconstructive techniques to ensure proper healing and function of the mouth.
For CPT code 40814, which pertains to the excision and repair of a lesion in the mouth, 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 apply if the lesion is particularly large or complex.
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 the 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 if the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used if 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 if the patient needs to return 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 if 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.
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 non-physician practitioners assist in the surgery.
14. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the mouth.
15. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the mouth.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 40814 is reimbursed by Medicare, but the specifics of reimbursement can vary based on several factors.
According to the Medicare Physician Fee Schedule (MPFS), the reimbursement rates for CPT codes are determined annually and can be influenced by geographic location, practice expense, and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for specific CPT codes.
Therefore, while CPT code 40814 is generally reimbursed by Medicare, healthcare providers should consult the MPFS and their respective MAC for precise reimbursement details and any potential local coverage determinations.
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