CPT code 11404 is for the excision of a benign skin lesion, including margins, measuring 3.1 to 4 cm.
CPT code 11404 is used for the excision of a benign (non-cancerous) skin lesion, including the margins, that measures between 3.1 to 4 centimeters in diameter. This code is specifically for procedures where the lesion is removed from areas other than the face, ears, eyelids, nose, lips, or mucous membrane.
For CPT code 11404, which involves excision of a benign lesion including margins, measuring 3.1 to 4.0 cm, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier if an evaluation and management (E/M) service was performed on the same day as the procedure and was significant and separately identifiable from the procedure.
3. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure was performed on both sides of the body.
4. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures were performed during the same surgical session.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the same procedure was repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the same procedure was repeated by a different physician.
8. 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 during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon was required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if the same laboratory test was repeated on the same day to obtain subsequent test results.
14. Modifier LT - Left Side: Use this modifier if the procedure was performed on the left side of the body.
15. Modifier RT - Right Side: Use this modifier if the procedure was performed on the right side of the body.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11404 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, and it is essential to consult this schedule to determine the exact reimbursement rate for CPT code 11404.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining coverage policies for specific CPT codes. Each MAC may have localized policies and guidelines that can affect the reimbursement process. Therefore, it is advisable to check with the relevant MAC for any specific requirements or documentation needed to ensure proper reimbursement for CPT code 11404.
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