CPT code 11312 is for the procedure of shaving a skin lesion that measures between 1.1 and 2.0 cm in size.
CPT code 11312 is used to describe the procedure of shaving a skin lesion that measures between 1.1 and 2.0 centimeters. This code is specifically utilized when a healthcare provider removes a lesion by shaving it off the surface of the skin, rather than cutting it out entirely. This method is often employed for diagnostic purposes or to remove benign or potentially malignant skin growths.
When using CPT code 11312 for the shave removal of a skin lesion measuring 1.1 to 2.0 cm, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
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 removal.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the shave removal was a distinct service from other procedures 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. Use this modifier 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. This modifier is used if an unrelated procedure is performed during the postoperative period of the initial procedure.
7. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. Use this modifier if the shave removal is part of a planned series of procedures.
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 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 the initial procedure.
11. Modifier LT: Left side. Use this modifier if the procedure was performed on the left side of the body.
12. Modifier RT: Right side. Use this modifier if the procedure was performed on the right side of the body.
13. Modifier GA: Waiver of liability statement issued as required by payer policy, individual case. This modifier is used when an Advance Beneficiary Notice (ABN) is on file.
14. Modifier GX: Notice of liability issued, voluntary under payer policy. This modifier is used when a voluntary ABN is issued for services that are not covered.
15. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. This modifier is used when no ABN is on file and the service is expected to be denied.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
CPT code 11312, which pertains to a specific medical procedure, is reimbursed by Medicare under certain conditions. To determine if CPT 11312 is covered, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and coverage criteria for various CPT codes. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for interpreting national Medicare policies and may have specific local coverage determinations (LCDs) that affect reimbursement. By checking both the MPFS and the guidance from your MAC, you can confirm whether CPT 11312 is reimbursed by Medicare for your specific circumstances.
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