CPT code 11057 is used for the medical procedure of trimming more than four skin lesions.
CPT code 11057 is used to describe the medical procedure of trimming skin lesions when there are more than four lesions. This code is typically utilized by healthcare providers to document and bill for the removal of multiple skin growths or abnormalities in a single session. The procedure involves carefully trimming the lesions to improve the patient's skin condition or to prepare the lesions for further treatment or examination.
For CPT code 11057, which involves the trimming of skin lesions over four, 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. This modifier is used when an E/M service is provided on the same day as the procedure and is distinct from the procedure performed.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used when a procedure or service is repeated by the same provider on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used when a procedure or service is repeated by a different provider on the same day.
5. 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. This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial procedure.
6. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
7. Modifier LT: Left side (used to identify procedures performed on the left side of the body). This modifier is used to specify that the procedure was performed on the left side of the body.
8. Modifier RT: Right side (used to identify procedures performed on the right side of the body). This modifier is used to specify that the procedure was performed on the right side of the body.
9. Modifier XS: Separate structure. This modifier is used to indicate that a service was performed on a separate organ/structure.
10. Modifier XE: Separate encounter. This modifier is used to indicate that a service was performed during a separate encounter.
11. Modifier XP: Separate practitioner. This modifier is used to indicate that a service was performed by a different practitioner.
12. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that the use of a service that is distinct because it does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed and ensure accurate billing and reimbursement.
The CPT code 11057 is reimbursed by Medicare, but its reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
However, the final determination of whether CPT code 11057 is reimbursed can also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and may have additional local coverage determinations (LCDs) that affect reimbursement.
Therefore, it is essential to consult both the MPFS and your regional MAC to ensure compliance and proper reimbursement for CPT code 11057.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 11057, and by individual payer. Schedule a demo today to see how RevFind can help you identify and recover lost revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
