CPT code 11045 is used for billing additional debridement of subcutaneous tissue, typically as an add-on to a primary procedure.
CPT code 11045 is used to describe the debridement of subcutaneous tissue, which is an additional procedure. This code is typically used when a healthcare provider needs to remove dead, damaged, or infected tissue from beneath the skin to promote healing and prevent infection. The "add-on" designation means that this code is used in conjunction with another primary procedure code, indicating that the debridement is an additional service provided during the same session.
For CPT code 11045, which pertains to the debridement of subcutaneous tissue as an add-on procedure, 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. This modifier is used when an E/M service is provided on the same day as the debridement procedure.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the debridement procedure is 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 health care professional. This modifier is used if the debridement procedure is repeated on the same day by the same provider.
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 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 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 procedure is unrelated to the original procedure and occurs during the postoperative period of the initial surgery.
7. Modifier XE: Separate encounter. This modifier is used to indicate that the debridement procedure occurred during a separate encounter on the same day.
8. Modifier XS: Separate structure. This modifier is used to indicate that the debridement procedure was performed on a separate organ/structure.
9. Modifier XP: Separate practitioner. This modifier is used to indicate that the debridement procedure was performed by a different practitioner.
10. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that the debridement procedure does not overlap usual components of the main service.
These modifiers help to provide additional information about the circumstances under which the debridement procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11045, which is an add-on code, is reimbursed by Medicare under specific conditions. To determine if CPT 11045 is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including add-on codes like 11045.
Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide region-specific information regarding the reimbursement of CPT 11045. They can also offer guidance on any documentation or billing requirements that must be met to ensure proper reimbursement.
In summary, while CPT 11045 is reimbursed by Medicare, providers must verify the specific reimbursement details through the MPFS and their local MAC to ensure compliance and accurate billing.
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