CPT code 11400 is for the excision of a benign lesion including margins, measuring 0.5 cm or less, on the trunk, arms, or legs.
CPT code 11400 is used to describe the excision of a benign (non-cancerous) skin lesion, including the margins, with a total diameter of 0.5 centimeters or less. This code is typically used by healthcare providers to document and bill for the removal of small, benign skin growths.
For CPT code 11400, 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 on the same day as the excision.
2. Modifier 50: Bilateral procedure. Use this modifier if the excision was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the excision was distinct or independent from other services performed on the same day.
5. Modifier 76: Repeat procedure or service by the same physician. Use this modifier if the same procedure was repeated on the same day by the same physician.
6. Modifier 77: Repeat procedure by another physician. Use this modifier if the same procedure was repeated on the same day by a different physician.
7. 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 had to return to the operating room for a related procedure.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if an unrelated procedure was performed during the postoperative period of the initial procedure.
9. Modifier LT: Left side. Use this modifier to indicate that the procedure was performed on the left side of the body.
10. Modifier RT: Right side. Use this modifier to indicate that the procedure was performed on the right side of the body.
11. Modifier GA: Waiver of liability statement issued as required by payer policy, individual case. Use this modifier if an Advance Beneficiary Notice (ABN) was issued for the procedure.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. Use this modifier if a voluntary ABN was issued for the procedure.
13. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. Use this modifier if no ABN was issued and the service is expected to be denied.
14. Modifier QX: CRNA service with medical direction by a physician. Use this modifier if a Certified Registered Nurse Anesthetist (CRNA) provided the service under the medical direction of a physician.
15. Modifier QY: Medical direction of one CRNA by an anesthesiologist. Use this modifier if an anesthesiologist provided medical direction for one CRNA.
16. Modifier QK: Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals. Use this modifier if an anesthesiologist provided medical direction for multiple concurrent anesthesia procedures.
17. Modifier QS: Monitored anesthesia care service. Use this modifier if monitored anesthesia care was provided during the procedure.
18. Modifier G8: Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedures. Use this modifier if the procedure required deep monitored anesthesia care.
19. Modifier G9: Monitored anesthesia care for patient who has a history of severe cardiopulmonary condition. Use this modifier if the patient has a severe cardiopulmonary condition requiring monitored anesthesia care.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement.
When determining if CPT code 11400 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the payment rates used by Medicare to reimburse physicians and other healthcare providers for services rendered.
To verify if CPT code 11400 is reimbursed, you should:
1. Check the MPFS: Access the MPFS database to see if CPT code 11400 is listed and review the associated reimbursement rates. The MPFS will provide detailed information on whether the code is covered and the payment amount.
2. Consult Your MAC: Each MAC may have specific guidelines and coverage determinations that can affect reimbursement. Your MAC will provide the most accurate and region-specific information regarding the reimbursement status of CPT code 11400.
By cross-referencing both the MPFS and your MAC's guidelines, you can determine if CPT code 11400 is reimbursed by Medicare.
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