CPT code 11424 is for the excision of a benign lesion on the head, face, neck, or scalp, including margins, measuring 3.1 to 4 cm.
CPT code 11424 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 size of the lesion being removed, along with its margins, ranges from 3.1 to 4.0 centimeters. 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 11424, 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 and documented in addition to the procedure.
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 on the same day.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when the same procedure is 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. This modifier is used when a related procedure is performed during the postoperative period of the initial procedure.
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 GA: Waiver of liability statement issued as required by payer policy, individual case. This modifier is used when a waiver of liability statement is on file.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. This modifier is used when a voluntary notice of liability is issued.
13. Modifier GY: Item or service statutorily excluded, does not meet the definition of any Medicare benefit. This modifier is used when the service is excluded from Medicare coverage.
14. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. This modifier is used when the provider expects that Medicare will deny the service as not reasonable and necessary.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement.
The CPT code 11424 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 11424. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining local coverage decisions. Each MAC may have specific guidelines and reimbursement rates for CPT code 11424, which can influence the final payment amount. Therefore, it is essential for healthcare providers to consult their respective MAC for detailed information on the reimbursement process and any local variations that may apply.
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