CPT code 11055 is a medical code used to describe the procedure of trimming a skin lesion.
CPT code 11055 is used to describe the medical procedure of trimming a skin lesion. This code is typically utilized when a healthcare provider removes a small, superficial growth or abnormality on the skin, such as a callus or corn, using a sharp instrument. The procedure is generally performed to alleviate discomfort or prevent further complications.
For CPT code 11055 (Trim skin lesion), the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the trimming of the skin lesion.
2. Modifier 50: Bilateral procedure. Use this modifier if the trimming of skin lesions was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures, including the trimming of skin lesions, were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the trimming of the skin lesion was a distinct service from other procedures performed on the same day.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. Use this modifier if the trimming of the skin lesion was repeated on the same day by the same provider.
6. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. Use this modifier if the trimming of the skin lesion was repeated on the same day by a different provider.
7. Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient had to return for additional trimming of the skin lesion during the postoperative period.
8. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. Use this modifier if the trimming of the skin lesion was unrelated to a previous procedure performed during the postoperative period.
9. Modifier 91: Repeat clinical diagnostic laboratory test. Use this modifier if the trimming of the skin lesion required repeat laboratory tests on the same day.
10. Modifier LT: Left side. Use this modifier if the trimming of the skin lesion was performed on the left side of the body.
11. Modifier RT: Right side. Use this modifier if the trimming of the skin lesion was performed on the right side of the body.
These modifiers help provide additional information about the circumstances under which the trimming of the skin lesion was performed, ensuring accurate billing and reimbursement.
The CPT code 11055 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates.
Additionally, reimbursement for CPT code 11055 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the specific reimbursement policies and rates for CPT code 11055.
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