CPT code 11200 is for the removal of up to 15 skin tags, a common procedure in dermatology.
CPT code 11200 is used for the removal of skin tags, specifically when the procedure involves the removal of up to 15 skin tags. This code is typically utilized by healthcare providers to document and bill for the service of excising these benign skin growths, which can be performed for either medical or cosmetic reasons.
For CPT code 11200, which pertains to the removal of skin tags, 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. This modifier is used when an E/M service is provided on the same day as the procedure and is distinct from the procedure itself.
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 helps to avoid bundling issues and ensures that the procedure is recognized as a separate service.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used when the same procedure is repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when 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 following initial procedure for a related procedure during the postoperative period. This modifier is used when the patient needs to return to the operating room for a related procedure during the postoperative period.
6. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. This modifier is used when an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
7. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used when the same laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help to provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 11200, which involves the removal of skin tags, is reimbursed by Medicare under specific conditions. According to the Medicare Physician Fee Schedule (MPFS), reimbursement for this code is contingent upon medical necessity and proper documentation. Medicare Administrative Contractors (MACs) play a crucial role in determining the coverage and reimbursement criteria for CPT 11200. They may have specific Local Coverage Determinations (LCDs) that outline the circumstances under which this procedure is considered medically necessary. Therefore, it is essential for healthcare providers to consult the relevant MAC guidelines and ensure that all required documentation is in place to secure reimbursement for CPT 11200.
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