CPT code 11421 is for the excision of a benign lesion on the face, neck, or scalp, including margins, measuring 0.6 to 1.0 cm.
CPT code 11421 is used to describe the excision of benign (non-cancerous) skin lesions, including the margins, on areas such as the head, face, neck, or scalp. The size of the lesion being removed, along with its margins, ranges from 0.6 to 1.0 centimeters. This code is specifically utilized to document and bill for the surgical removal of these types of skin lesions in the specified regions.
For CPT code 11421, 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 excision procedure.
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 surgical session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the excision was a distinct service from other procedures 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 if the excision was performed on the left side of the body.
10. Modifier RT: Right side. Use this modifier if the excision was performed on the right side of the body.
11. Modifier XS: Separate structure. Use this modifier to indicate that the excision was performed on a separate structure from other procedures performed on the same day.
12. Modifier XE: Separate encounter. Use this modifier to indicate that the excision was performed during a separate encounter from other procedures performed on the same day.
13. Modifier XP: Separate practitioner. Use this modifier to indicate that the excision was performed by a different practitioner from other procedures performed on the same day.
14. Modifier XU: Unusual non-overlapping service. Use this modifier to indicate that the excision was an unusual, non-overlapping service from other procedures performed on the same day.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement.
Determining whether CPT code 11421 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
To verify if CPT code 11421 is reimbursed, you should first check the MPFS database, which is accessible through the Centers for Medicare & Medicaid Services (CMS) website. Enter the specific CPT code to see if it is listed and to review the associated reimbursement details.
Additionally, each MAC may have specific guidelines or local coverage determinations (LCDs) that could affect the reimbursement status of CPT code 11421. Therefore, it is crucial to consult the MAC that administers Medicare claims in your region to ensure compliance with any local policies.
In summary, to determine if CPT code 11421 is reimbursed by Medicare, you need to review the MPFS and consult your regional MAC for any specific coverage guidelines.
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