CPT code 11005 is for the debridement of the abdominal wall, a procedure to remove dead or infected tissue to promote healing.
CPT code 11005 is used to describe the medical procedure of debridement of the abdominal wall. This involves the surgical removal of dead, damaged, or infected tissue from the abdominal area to promote healing and prevent further infection. This code is typically used by healthcare providers to document and bill for this specific type of wound care treatment.
For CPT code 11005 (Debride abdom wall), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. This could be due to increased complexity or difficulty of the debridement.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the debridement is performed on both sides of the abdominal wall during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including the debridement of the abdominal wall, are performed during the same surgical session.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is appropriate if the debridement is planned or staged as part of a series of procedures.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the debridement is 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 debridement procedure needs to be repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the debridement procedure is repeated by a different provider.
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 needs to return to the operating room for a related debridement procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the debridement is unrelated to the original procedure and occurs during the postoperative period of the initial surgery.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon is required to help perform the debridement.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon is 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
- This modifier is used when a non-physician provider assists in the surgery.
Each modifier serves a specific purpose and should be used according to the clinical scenario and payer guidelines to ensure accurate billing and reimbursement.
CPT code 11005, which involves debridement of the abdominal wall, 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 CPT codes, including 11005. Additionally, reimbursement can vary slightly depending on the region, as Medicare Administrative Contractors (MACs) may have localized adjustments. Therefore, it is advisable to consult the relevant MAC for the most accurate and up-to-date reimbursement information for CPT code 11005.
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