CPT code 11310 is for the procedure of shaving a skin lesion that is 0.5 cm or smaller.
CPT code 11310 is used to describe the procedure of shaving a skin lesion that is 0.5 centimeters or smaller in diameter. This code is typically used when a healthcare provider removes a lesion by shaving it off the surface of the skin, rather than excising it completely. This method is often employed for diagnostic purposes or to remove benign lesions that are causing discomfort or cosmetic concerns.
For CPT code 11310, which pertains to the shaving of a skin lesion measuring 0.5 cm or less, 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 health care 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 procedure.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple lesions are treated or if the procedure is performed in conjunction with another procedure.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier 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 health care 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 health care professional following initial procedure for a related procedure during the postoperative period. This modifier is used if a related procedure is required during the postoperative period.
6. Modifier 79: Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period. Use this modifier 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 was performed on a separate organ/structure.
10. Modifier XE: Separate encounter. This modifier is used to indicate that a service was performed during a separate encounter.
11. Modifier XP: Separate practitioner. This modifier is used to indicate that a service was performed by a different practitioner.
12. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information to payers about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11310 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 costs.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret national policies and set local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement rate and any specific requirements or limitations associated with CPT code 11310.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 11310. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
