CPT code 11105 is for a punch biopsy of the skin, each separate or additional lesion.
CPT code 11105 is used to describe a procedure where a healthcare provider performs a punch biopsy of the skin. This code specifically applies to each separate or additional biopsy taken during the same session. A punch biopsy involves using a circular blade to remove a small, cylindrical sample of skin tissue for further examination, typically to diagnose skin conditions or diseases.
Certainly! Here are the modifiers that could be used with CPT code 11105, along with the reasons for each:
1. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Use this modifier when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the procedure.
2. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier when the same procedure is repeated by the same physician on the same day.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- This modifier is used when the same procedure is repeated by a different physician on the same day.
5. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- Although less common for this specific CPT code, this modifier can be used if the procedure involves a repeat clinical diagnostic laboratory test.
6. Modifier LT - Left Side
- Use this modifier to indicate that the procedure was performed on the left side of the body.
7. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right side of the body.
8. Modifier XS - Separate Structure
- This modifier is used to indicate that a service is distinct because it was performed on a separate organ/structure.
9. Modifier XE - Separate Encounter
- Use this modifier to indicate that a service is distinct because it was performed during a separate encounter.
10. Modifier XP - Separate Practitioner
- This modifier is used to indicate that a service is distinct because it was performed by a different practitioner.
11. Modifier XU - Unusual Non-Overlapping Service
- Apply this modifier 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 procedure was performed, ensuring accurate billing and reimbursement.
CPT code 11105 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, and it is essential to consult this schedule to determine the exact reimbursement rate for CPT code 11105.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and ensuring compliance with Medicare policies. Each MAC may have specific local coverage determinations (LCDs) that can affect the reimbursement of CPT code 11105. Therefore, it is advisable to review both the MPFS and any relevant LCDs from your regional MAC to ensure proper billing and reimbursement for this code.
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