CPT code 11313 is for the procedure of shaving a skin lesion that is larger than 2.0 cm.
CPT code 11313 is used to describe the procedure of shaving a skin lesion that is larger than 2.0 centimeters. This code is specifically for instances where a healthcare provider removes a lesion by shaving it off the skin, rather than cutting it out entirely. The size specification indicates that the lesion being treated is more than 2.0 centimeters in diameter. This code helps ensure accurate billing and documentation for this particular type of skin lesion removal.
For CPT code 11313, which pertains to the shaving of a skin lesion greater than 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 or other qualified health care professional 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 a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used when a procedure or service is repeated by the same provider on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when a procedure or service is repeated by a different provider on the same day.
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 when a patient needs to return to the operating room for a related procedure during the postoperative period of the initial procedure.
6. Modifier 79: Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period. This modifier is used when a procedure or service is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
7. Modifier 58: Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period. This modifier is used when a procedure or service during the postoperative period was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
8. Modifier LT: Left side. This modifier is used to indicate that the procedure was performed on the left side of the body.
9. Modifier RT: Right side. This modifier is used to indicate that the procedure was performed on the right side of the body.
10. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed at the same session by the same provider. It indicates that the additional procedures are distinct and separate from the primary procedure.
11. Modifier 22: Increased procedural services. This modifier is used when the work required to provide a service is substantially greater than typically required.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement.
CPT code 11313, which involves the shaving of a skin lesion greater than 2.0 cm, is reimbursed by Medicare. The reimbursement rates for this procedure can be found in the Medicare Physician Fee Schedule (MPFS), which outlines the payment amounts for various medical services covered by Medicare.
Additionally, the specific reimbursement details and any potential variations in coverage can be further clarified by consulting the relevant Medicare Administrative Contractor (MAC) for your region. Each MAC may have specific guidelines and policies that impact the reimbursement process for CPT code 11313.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 11313. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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