CPT code 11044 is for the surgical debridement of bone, covering an area of 20 square centimeters or less.
CPT code 11044 is used to describe the surgical procedure of debridement of bone. Specifically, it refers to the removal of dead, damaged, or infected bone tissue from a wound area that is 20 square centimeters or less. This procedure is essential for promoting healing and preventing further infection in patients with severe wounds or bone infections.
When using CPT code 11044, which pertains to debridement of bone 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 procedure was distinct or independent from other services performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. Use this modifier if the debridement procedure was repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used if the debridement procedure was repeated on the same day by a different provider.
5. Modifier 78: Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient had to return for additional debridement related to the initial procedure.
6. Modifier 79: Unrelated procedure or service by the same physician 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 during the postoperative period. Use this modifier if the debridement is part of a planned, staged series of procedures.
8. Modifier LT: Left side. This modifier is used to indicate that the procedure was performed on the left side of the body.
9. Modifier RT: Right side. This modifier is used to indicate that the procedure was performed on the right side of the body.
10. Modifier XS: Separate structure. This modifier is used to indicate that a service was performed on a separate organ/structure.
11. Modifier XE: Separate encounter. This modifier is used to indicate that a service was performed during a separate encounter.
12. Modifier XP: Separate practitioner. This modifier is used to indicate that a service was performed by a different practitioner.
13. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that the service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the debridement procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11044 is reimbursed by Medicare, but its 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 refer to the MPFS, which is updated annually by the Centers for Medicare & Medicaid Services (CMS). Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing these guidelines at the local level. Therefore, it is advisable for providers to consult their respective MACs for detailed information on the reimbursement criteria and any regional variations that may apply to CPT code 11044.
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