CPT code 40818 is used for excising oral mucosa to obtain tissue for grafting procedures in dental and oral surgery.
CPT code 40818 is used to describe the procedure of excising oral mucosa for the purpose of obtaining a graft. This involves the surgical removal of a section of the mucosal tissue from the mouth, which can then be used to repair or reconstruct other areas within the oral cavity or for other medical needs. This code is relevant for healthcare providers performing oral surgeries or related procedures that require tissue grafting.
When billing for the procedure associated with CPT code 40818, it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 40818, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. Documentation must support the increased complexity.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the mouth during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that the procedure is one of several performed.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the procedure was repeated by a different physician on the same day.
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
- Apply this modifier if the patient required an unplanned 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
- Use this modifier if the procedure was unrelated to the original procedure and was performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was required to perform the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was necessary because a qualified resident surgeon was unavailable.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a non-physician provider assisted in the surgery.
Proper use of these modifiers ensures that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
CPT code 40818 is reimbursed by Medicare. This code is listed on the Medicare Physician Fee Schedule (MPFS), indicating that it is a covered service. However, coverage and reimbursement may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's essential to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 40818. Don't leave money on the table—schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
