CPT code 11307 is for the procedure of shaving a skin lesion that measures between 1.1 and 2.0 cm.
CPT code 11307 is used to describe the procedure of shaving a skin lesion that measures between 1.1 to 2.0 centimeters. This code is specifically for the removal of a lesion by shaving, which involves using a sharp instrument to remove the lesion at or just below the level of the skin. This procedure is typically performed to remove benign (non-cancerous) or malignant (cancerous) skin growths for diagnostic or therapeutic purposes.
For CPT code 11307, which pertains to the shaving of a skin lesion measuring 1.1 to 2.0 cm, 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 shave procedure.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the shave procedure was distinct or independent from other services 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 same 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 procedure was 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 if the patient needs to return for a related procedure during the postoperative period.
6. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the shave procedure is performed during the postoperative period of another, unrelated procedure.
7. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. This modifier is used if the shave procedure is planned or staged during the postoperative period of another procedure.
8. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same session.
9. Modifier 22: Increased procedural services. Use this modifier if the shave procedure required significantly more work than usual.
10. Modifier 24: Unrelated evaluation and management service by the same physician during a postoperative period. This modifier is used if an unrelated E/M service is provided during the postoperative period of another procedure.
These modifiers help provide additional information about the circumstances under which the shave procedure was performed, ensuring accurate billing and reimbursement.
CPT code 11307, which involves a specific medical procedure, is reimbursed by Medicare under certain conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 11307.
Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for specific coverage policies and any potential local coverage determinations (LCDs) that may affect reimbursement. MACs are responsible for processing Medicare claims and can provide region-specific information that may influence whether CPT code 11307 is reimbursed in a particular area.
Therefore, while CPT code 11307 is generally reimbursable by Medicare, providers must verify the specifics through the MPFS and their respective MAC to ensure compliance and accurate reimbursement.
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