CPT code 11422 is for the excision of a benign lesion on the head, face, neck, or scalp with margins of 1.1 to 2 cm.
CPT code 11422 is used to describe the excision of a benign (non-cancerous) lesion, including the margins, from areas such as the head, face, neck, or scalp. The lesion being removed measures between 1.1 to 2.0 centimeters in diameter. This code is specific to procedures where the lesion is excised with a margin of normal tissue around it to ensure complete removal.
For CPT code 11422, 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. This modifier is used when an E/M service is performed on the same day as the procedure and is distinct from the procedure itself.
2. Modifier 50: Bilateral procedure. This modifier is used if the procedure is performed on both sides of the body.
3. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same surgical session.
4. 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.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used when the same procedure is repeated by the same provider.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when the same procedure is repeated by a different provider.
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. This modifier is used when a related procedure is performed during the postoperative period.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. This modifier is used when an unrelated procedure is performed during the postoperative period of the initial procedure.
9. Modifier LT: Left side. This modifier is used to indicate that the procedure was performed on the left side of the body.
10. Modifier RT: Right side. This modifier is used to indicate that the procedure was performed on the right side of the body.
11. Modifier XS: Separate structure. This modifier is used to indicate that a service was performed on a separate organ/structure.
12. Modifier XE: Separate encounter. This modifier is used to indicate that a service was performed during a separate encounter.
13. Modifier XP: Separate practitioner. This modifier is used to indicate that a service was performed by a different practitioner.
14. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that a service does not overlap usual components of the main service.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 11422 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. Additionally, the reimbursement for CPT code 11422 may vary depending on the local policies and determinations made by the Medicare Administrative Contractor (MAC) for your region.
It is essential to consult the MPFS and your regional MAC to confirm the specific reimbursement details and any additional requirements that may apply.
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