CPT code 11100 is a medical code used to describe the procedure of performing a biopsy on a skin lesion.
CPT code 11100 is used to describe the procedure of performing a biopsy on a skin lesion. This code is specifically for the first lesion biopsied and involves the removal of a small sample of skin tissue for diagnostic purposes. The sample is then examined under a microscope to determine if there are any abnormalities, such as cancer or other skin conditions. This code is essential for accurate billing and documentation in the healthcare revenue cycle.
For CPT code 11100, which pertains to a biopsy of a skin lesion, 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 biopsy.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the biopsy was a distinct service from other procedures performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the biopsy procedure was repeated on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used if the biopsy was repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used if the biopsy was repeated for clinical diagnostic purposes.
6. Modifier 26: Professional component. Use this modifier if only the professional component of the biopsy service was provided.
7. Modifier TC: Technical component. This modifier is used if only the technical component of the biopsy service was provided.
8. Modifier 51: Multiple procedures. This modifier is used when multiple procedures, including the biopsy, are performed during the same session.
9. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. Use this modifier if the biopsy is part of a staged or related procedure.
10. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. This modifier is used if the biopsy is unrelated to the original procedure performed during the postoperative period.
11. Modifier 24: Unrelated evaluation and management service by the same physician during a postoperative period. Use this modifier if an E/M service unrelated to the biopsy was provided during the postoperative period of another procedure.
These modifiers help provide additional information about the circumstances under which the biopsy was performed, ensuring accurate billing and reimbursement.
The CPT code 11100 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, including CPT code 11100. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have different local coverage determinations and payment policies. Therefore, healthcare providers should consult their respective MAC for precise information regarding the reimbursement of CPT code 11100.
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