CPT code 11423 is for the excision of a benign lesion including margins on the face, ears, eyelids, nose, lips, or mucous membrane, measuring 2.1-3 cm.
CPT code 11423 is used to describe the excision of a benign (non-cancerous) lesion, including margins, on the face, ears, eyelids, nose, lips, or mucous membrane, with the lesion size being between 2.1 to 3.0 centimeters. This code is specific to procedures where the lesion is removed along with a margin of surrounding tissue to ensure complete excision.
For CPT code 11423, 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 procedure.
2. Modifier 50: Bilateral procedure. Use this modifier if the procedure 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 procedure 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. Use this modifier if the procedure was repeated on the same day by the same provider.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the procedure was repeated on the same day 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. Use this modifier if the patient required an unplanned return to the operating room.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the procedure was unrelated to the original surgery and occurred during the postoperative period.
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 XS: Separate structure. Use this modifier to indicate that a service was performed on a separate organ/structure.
12. Modifier XE: Separate encounter. Use this modifier to indicate that a service was performed during a separate encounter.
13. Modifier XP: Separate practitioner. Use this modifier to indicate that a service was performed by a different practitioner.
14. Modifier XU: Unusual non-overlapping service. Use this modifier to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11423 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs may have specific guidelines or requirements for reimbursement, so it is crucial to consult with your local MAC to ensure compliance and accurate billing.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 11423. With RevFind, you can ensure you're receiving the full reimbursement you're entitled to from each payer. Schedule a demo today to see how RevFind can optimize your revenue cycle management and enhance your financial performance.
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