CPT code 11104 is a medical code used to describe a procedure for performing a punch biopsy on a single skin lesion.
CPT code 11104 is used to describe a procedure where a healthcare provider performs a punch biopsy on a single skin lesion. This involves using a circular blade to remove a small, cylindrical sample of skin tissue for diagnostic purposes. The sample is then typically sent to a lab for further examination to determine the presence of any abnormalities, such as cancer or other skin conditions.
For CPT code 11104 (Punch biopsy of skin, single 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 punch biopsy.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It may be necessary if multiple procedures are performed and need to be billed separately.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the same 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 if the same procedure is repeated on the same day by a different provider.
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 if the patient needs to return for a related procedure within the postoperative period.
6. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. This modifier is used if an unrelated procedure is performed during the postoperative period of the initial procedure.
7. Modifier LT: Left side. This modifier is used to specify that the procedure was performed on the left side of the body.
8. Modifier RT: Right side. 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 is distinct because it was performed on a separate organ/structure.
10. Modifier XE: Separate encounter. This modifier is used to indicate that a service is distinct because it was performed during a separate encounter.
11. Modifier XP: Separate practitioner. This modifier is used to indicate that a service is distinct because it was performed by a different practitioner.
12. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that a service 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 punch biopsy was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 11104 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the payment rates used by Medicare to reimburse physicians and other healthcare providers for services rendered.
CPT code 11104 is generally reimbursed by Medicare, but the exact reimbursement rate and any specific coverage criteria can vary based on the MAC's local coverage determinations (LCDs). It is advisable to review the MPFS for the current year and consult your MAC's policies to ensure compliance and accurate reimbursement for CPT code 11104.
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