CPT code 11004 is for the debridement of genitalia and perineum, a medical procedure to remove dead or infected tissue.
CPT code 11004 is used to describe the medical procedure for debriding, or surgically removing, dead, damaged, or infected tissue from the genitalia and perineum. This procedure is essential for promoting healing and preventing further infection in these sensitive areas.
When using CPT code 11004 for debridement of genitalia and perineum, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the debridement was performed on both sides of the genitalia and perineum.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the debridement is part of a staged or related procedure during the postoperative period.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the debridement was a distinct procedural service from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Apply this modifier if the same procedure was repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the procedure was repeated by a different provider.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- Apply this modifier 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
- Use this modifier if the debridement was unrelated to the original procedure performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.
13. 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 context and specificity to the billing and coding process, ensuring accurate reimbursement and documentation.
CPT code 11004 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, reimbursement can vary based on the local policies of the Medicare Administrative Contractor (MAC) that services your geographic area. Therefore, it is advisable to consult the MPFS and your regional MAC to confirm the exact reimbursement rate and any specific billing requirements for CPT code 11004.
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