CPT code 41252 is used to identify the procedure for repairing a laceration on the tongue in healthcare billing and documentation.
CPT code 41252 is used to describe the procedure of repairing a laceration (cut) on the tongue. This code specifically indicates that the repair involves suturing or stitching the tissue to promote healing and restore the tongue's function and appearance after an injury.
For CPT code 41252, which pertains to the repair of a tongue laceration, 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 tongue laceration repair is more complex than usual.
2. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This could apply if the repair was less extensive than typically required.
3. 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. This could apply if the tongue laceration repair was performed in conjunction with other procedures that are not typically performed together.
4. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when a procedure or service is repeated by the same physician. This could apply if the tongue laceration repair needed to be repeated due to complications or other reasons.
5. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician. This could apply if the initial repair was performed by one physician and a subsequent repair was performed by another.
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: Used when a patient returns to the operating room for a related procedure during the postoperative period. This could apply if complications from the initial tongue laceration repair necessitated a return to the operating room.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure. This could apply if the patient required an unrelated procedure during the postoperative period of the tongue laceration repair.
8. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure. This could apply if the complexity of the tongue laceration repair necessitated an assistant surgeon.
9. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure. This could apply if the repair required minimal assistance.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required because a qualified resident surgeon is not available. This could apply if the repair required an assistant surgeon under these specific circumstances.
11. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery. This could apply if such a professional assisted in the tongue laceration repair.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement.
When determining if a specific CPT code, such as 41252, is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing Medicare policies at the regional level.
For CPT code 41252, you would need to verify its inclusion and reimbursement rate on the MPFS. If the code is listed, it indicates that Medicare reimburses for this service. However, it is also important to check with your specific MAC, as they may have additional guidelines or requirements that could affect reimbursement.
In summary, to determine if CPT code 41252 is reimbursed by Medicare, you should review the MPFS and consult with your regional MAC for any additional stipulations.
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