CPT code 11311 is for the procedure of shaving a skin lesion that measures between 0.6 and 1.0 cm in diameter.
CPT code 11311 is used to describe the procedure of shaving a skin lesion that measures between 0.6 and 1.0 centimeters in diameter. 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 method is typically employed for diagnostic purposes or to remove benign or potentially malignant skin growths.
For CPT code 11311, which pertains to the shaving of a skin lesion measuring 0.6-1.0 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 is 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 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 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 LT: Left side. This modifier is used to indicate that the procedure was performed on the left side of the body.
8. Modifier RT: Right side. This modifier is used to indicate that the procedure was performed on the right side of the body.
9. Modifier 50: Bilateral procedure. Use this modifier if the shave procedure was performed on both sides of the body.
10. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same session.
11. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. Use this modifier if the shave procedure is part of a planned series of procedures.
12. Modifier 22: Increased procedural services. This modifier is used if the procedure required significantly more work than usual.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
CPT code 11311, which pertains to the shaving of a skin lesion measuring 0.6-1.0 cm, is generally reimbursed by Medicare. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. However, it is important to note that the final determination of reimbursement can vary based on the specific guidelines and policies of the Medicare Administrative Contractor (MAC) that services your region. Each MAC may have unique coverage criteria and documentation requirements that must be met for the service to be reimbursed. Therefore, it is advisable to consult the local MAC's policies and the MPFS to ensure compliance and accurate reimbursement.
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