CPT code 11042 is for the debridement of subcutaneous tissue for wounds up to 20 square centimeters or less.
CPT code 11042 is used to describe the debridement of subcutaneous tissue, which involves the removal of dead, damaged, or infected tissue to help a wound heal. This specific code applies when the debridement covers an area of 20 square centimeters or less.
For CPT code 11042, which pertains to the debridement of subcutaneous tissue for wounds up to 20 square centimeters or less, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the debridement.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the debridement is a distinct service from other procedures performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the debridement procedure is repeated on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used if the debridement procedure is repeated on the same day by a different provider.
5. 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. Use this modifier if the patient needs to return for additional debridement related to the initial procedure.
6. Modifier 79: Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period. This modifier is used if the debridement is unrelated to the original procedure performed during the postoperative period.
7. Modifier 58: Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period. Use this modifier if the debridement is planned or staged as part of the treatment plan.
8. Modifier LT: Left side (used to identify procedures performed on the left side of the body).
9. Modifier RT: Right side (used to identify procedures performed on the right side of the body).
10. Modifier XS: Separate structure. This modifier is used to indicate that the debridement was performed on a separate organ/structure.
11. Modifier XE: Separate encounter. This modifier is used to indicate that the debridement was performed during a separate encounter on the same day.
12. Modifier XP: Separate practitioner. This modifier is used to indicate that the debridement was performed by a different practitioner.
13. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that the debridement does not overlap with other services provided.
These modifiers help provide additional information about the circumstances under which the debridement was performed, ensuring accurate billing and reimbursement.
CPT code 11042 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable coverage limitations, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the local Medicare Administrative Contractor (MAC) for any region-specific policies or additional documentation requirements that may affect reimbursement for CPT code 11042.
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