CPT code 11443 is for the excision of a benign lesion on the face, measuring 2.1-3 cm, including margins.
CPT code 11443 is used to describe the excision of a benign (non-cancerous) lesion on the face, including margins, that measures between 2.1 to 3 centimeters. This code is specifically for procedures where the lesion is removed with a margin of normal tissue around it to ensure complete excision.
For CPT code 11443, which pertains to the excision of a benign lesion including margins on the face, measuring 2.1 to 3.0 cm, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Used when an E/M service is performed on the same day as the procedure.
3. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
4. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same session.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service 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: Used when the same procedure is repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Used when the same procedure is repeated by a different provider.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: Used when a related procedure is performed during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Used when an unrelated procedure is performed during the postoperative period.
10. Modifier 90 - Reference (Outside) Laboratory: Used when laboratory procedures are performed by a party other than the treating or reporting physician.
11. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent test results.
12. Modifier 99 - Multiple Modifiers: Used when two or more modifiers are necessary to describe the service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 11443 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the payment rates used by Medicare to reimburse physicians and other healthcare providers for services rendered.
To verify the reimbursement status of CPT code 11443, you should:
1. Check the MPFS: Access the Medicare Physician Fee Schedule database to see if CPT code 11443 is listed and to review the associated reimbursement rates.
2. Consult Your MAC: Each MAC may have specific guidelines and coverage determinations that can affect whether a particular CPT code is reimbursed. They can provide detailed information on any regional variations or additional documentation requirements.
By following these steps, you can determine if CPT code 11443 is reimbursed by Medicare and ensure compliance with all relevant billing guidelines.
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