CPT code 11426 is for the excision of a benign lesion on the head, face, neck, or scalp, with margins greater than 4 cm.
CPT code 11426 is used to describe the excision of a benign (non-cancerous) lesion, including the margins, on the head, face, neck, hands, feet, or genitalia, where the lesion is greater than 4 centimeters in size. This code is specific to procedures where the lesion and a margin of surrounding tissue are surgically removed to ensure complete excision.
When using CPT code 11426, which pertains to the excision of a lesion, including margins, over 4 cm in diameter, on the head, face, neck, or scalp, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 (Bilateral Procedure): If the procedure was performed on both sides of the body, this modifier should be appended.
3. Modifier 51 (Multiple Procedures): Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is applicable if the procedure was planned or staged at the time of the original procedure.
5. 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.
6. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): This modifier is used if the same procedure was repeated by the same provider.
7. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Use this modifier if the procedure was repeated by a different provider.
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): This modifier is used 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.
10. Modifier 80 (Assistant Surgeon): This modifier is used if an assistant surgeon was necessary for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if a minimum assistant surgeon was required.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is applicable if an assistant surgeon was necessary because a qualified resident was not available.
13. Modifier 99 (Multiple Modifiers): Use this modifier if more than four modifiers are necessary to describe the service.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 11426 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect the reimbursement of CPT code 11426. Each MAC may have unique policies or requirements that could influence the reimbursement process.
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