CPT code 40845 is a medical billing code used for the reconstruction of the mouth, helping healthcare providers accurately document and bill for procedures.
CPT code 40845 is for the surgical procedure involving the reconstruction of the mouth. This code is used when a healthcare provider performs a surgical intervention to repair or restore the structure and function of the oral cavity, which may be necessary due to trauma, disease, or congenital conditions. The procedure aims to improve the patient's ability to eat, speak, and maintain oral hygiene.
For CPT code 40845 (Reconstruction of mouth), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required. This could be due to complications or unusual circumstances during the reconstruction.
2. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same surgical session. This is common in complex reconstructive surgeries where additional procedures are necessary.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could occur if the full reconstruction was not completed due to patient condition or other factors.
4. Modifier 53 - Discontinued Procedure
- This modifier is appropriate if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the reconstruction was distinct or independent from other services performed on the same day. This helps to clarify that the procedures were separate and necessary.
6. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons were required to perform the reconstruction. Each surgeon should report their distinct operative work.
7. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same physician needs to repeat the reconstruction procedure within a short period due to complications or other reasons.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician needs to repeat the reconstruction procedure within a short period.
9. 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 needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is appropriate if an unrelated procedure is performed by the same physician during the postoperative period of the initial reconstruction.
11. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary to complete the reconstruction procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
13. 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.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate reimbursement and documentation for the reconstruction of the mouth.
The CPT code 40845 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and consult with your Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates. Additionally, MACs can offer region-specific information and any potential variations in coverage or reimbursement policies.
Always ensure to check the latest updates and guidelines from both the MPFS and your MAC to confirm the reimbursement status for CPT code 40845.
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 40845. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.
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