CPT code 11047 is an add-on code used for debridement of bone, indicating additional work beyond the primary procedure.
CPT code 11047 is used to describe an additional procedure for the debridement of bone. This code is an add-on, meaning it is used in conjunction with another primary procedure code to indicate that additional bone debridement was necessary. This typically involves the surgical removal of dead, damaged, or infected bone tissue to promote healing and prevent further infection.
For CPT code 11047, which pertains to debridement of bone (each additional 20 sq cm or part thereof), the following modifiers may be applicable:
1. Modifier 59 (Distinct Procedural Service): Used to indicate that the procedure is distinct or independent from other services performed on the same day. This modifier is often used to bypass National Correct Coding Initiative (NCCI) edits.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier helps in indicating that the procedure is an additional service.
3. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician on the same day. This modifier is important for indicating that the repeated service is not a duplicate billing error.
4. Modifier 77 (Repeat Procedure by Another Physician): Applied when the same procedure is repeated by a different physician on the same day. This helps in distinguishing the service from potential duplicate billing.
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): Used when the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
6. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
7. Modifier XE (Separate Encounter): Indicates that a service is distinct because it occurred during a separate encounter. This is one of the X{EPSU} modifiers that provide greater specificity than modifier 59.
8. Modifier XS (Separate Structure): Used to indicate that a service is distinct because it was performed on a separate organ/structure.
9. Modifier XP (Separate Practitioner): Indicates that a service is distinct because it was performed by a different practitioner.
10. Modifier XU (Unusual Non-Overlapping Service): Used to indicate that a service is distinct because it does not overlap usual components of the main service.
These modifiers help in providing additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11047 is reimbursed by Medicare, but it is important to note that reimbursement is subject to specific conditions and guidelines.
According to the Medicare Physician Fee Schedule (MPFS), CPT code 11047 is considered an add-on code, which means it must be billed in conjunction with a primary procedure code.
The reimbursement for this code will depend on the primary procedure it is associated with and the local coverage determinations made by the Medicare Administrative Contractor (MAC) for your region.
Therefore, it is crucial to verify the specific guidelines and coverage criteria set forth by your MAC to ensure proper billing and reimbursement for CPT code 11047.
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