CPT code 42107 is for the excision of a lesion located on the roof of the mouth, used for billing and documentation in healthcare.
CPT code 42107 is used to describe the surgical procedure of excising a lesion located on the roof of the mouth. This code specifically indicates that the lesion is being removed through a surgical intervention, which may be necessary for diagnostic purposes or to treat conditions such as tumors or other abnormal growths in that area.
For CPT code 42107, which pertains to the excision of a lesion from the roof of the mouth, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as the size, location, or complexity of the lesion.
2. Modifier 50 - Bilateral Procedure
- If the procedure was performed on both sides of the roof of the mouth, this modifier should be used to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same surgical session. This helps to indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could be due to patient-specific factors or intraoperative findings.
5. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It helps to clarify that the excision was separate from other procedures.
6. Modifier 76 - Repeat Procedure by Same Physician
- If the same physician had to repeat the procedure on the same day, this modifier should be used to indicate the repeat nature of the service.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician had to repeat the procedure 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
- This modifier is used if the patient had 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
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required to help perform the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- This modifier indicates that a minimum assistant surgeon was necessary for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 42107, which involves the excision of a lesion from the roof of the mouth, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) for any region-specific guidelines or variations in reimbursement policies. The MACs are responsible for processing Medicare claims and can provide further clarification on coverage and payment details for CPT code 42107.
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