CPT code 41250 is used to describe the procedure for repairing a laceration on the tongue in healthcare billing and documentation.
CPT code 41250 is used to describe the surgical procedure for repairing a laceration of the tongue. This code indicates that a healthcare provider has performed a repair on a tongue injury, which may involve suturing or other techniques to restore the tongue's structure and function.
When billing for CPT code 41250 (Repair tongue laceration), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the repair of the tongue laceration required significantly more effort or time than usual.
2. Modifier 52 - Reduced Services: Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the repair of the tongue laceration was distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same physician needs to perform the repair of the tongue laceration more than once on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if a different physician needs to perform the repair of the tongue laceration on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is applicable if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the repair of the tongue laceration is performed during the postoperative period of another, unrelated procedure.
8. Modifier 80 - Assistant Surgeon: Apply this modifier if an assistant surgeon was necessary for the repair of the tongue laceration.
9. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
10. 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.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier if a PA, NP, or CNS assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining if CPT code 41250 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 41250 is reimbursed, you would need to check the MPFS for the specific year in question. Additionally, your regional MAC may have specific guidelines or policies that could affect reimbursement. It's crucial to review both the MPFS and any local coverage determinations (LCDs) issued by your MAC to ensure compliance and accurate billing.
For the most precise information, healthcare providers should access the MPFS database and consult their MAC's resources. This will provide the most up-to-date and region-specific information regarding the reimbursement status of CPT code 41250.
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