CPT code 11102 is for a tangential biopsy of a single skin lesion, used by healthcare providers for billing and documentation purposes.
CPT code 11102 is used to describe a tangential biopsy of a single skin lesion. This procedure involves removing a small, thin slice of skin from the lesion for examination, typically using a blade or a similar instrument. The goal is to diagnose or rule out skin conditions, including cancers, without removing the entire lesion.
For CPT code 11102, which pertains to a tangential biopsy of a single 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 biopsy.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the biopsy is a distinct service from other procedures performed on the same day. It is particularly useful when multiple procedures are performed and there is a need to distinguish the biopsy from other services.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. Use this modifier if the same biopsy procedure is repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used when the same biopsy procedure is repeated on the same day but by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although less common for biopsies, this modifier can be used if the biopsy is part of a series of diagnostic tests that need to be repeated for clinical reasons.
6. Modifier LT: Left side. Use this modifier if the biopsy is performed on a lesion located on the left side of the body.
7. Modifier RT: Right side. Use this modifier if the biopsy is performed on a lesion located on the right side of the body.
8. Modifier XS: Separate structure. This modifier is used to indicate that the biopsy was performed on a separate organ/structure from other procedures performed on the same day.
9. Modifier XE: Separate encounter. Use this modifier if the biopsy was performed during a separate encounter on the same day as other services.
10. Modifier XP: Separate practitioner. This modifier is used when the biopsy is performed by a different practitioner than other services provided on the same day.
11. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that the biopsy is distinct because it does not overlap with other services provided on the same day.
Each of these modifiers serves a specific purpose and should be used according to the clinical scenario and payer requirements to ensure accurate billing and reimbursement.
The CPT code 11102 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, and it is updated annually to reflect changes in policy and practice.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, healthcare providers should consult their respective MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 11102.
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