CPT code 11446 is for excising a facial skin lesion larger than 4 cm, including margins.
CPT code 11446 is used for the excision of a benign (non-cancerous) lesion, including the margins, on the face, ears, eyelids, nose, lips, or mucous membrane, where the lesion is greater than 4 centimeters in size. This code is specific to procedures where the lesion is removed with a margin of normal tissue around it to ensure complete excision.
For CPT code 11446, 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. This could be due to increased complexity or difficulty of the procedure.
2. Modifier 50 (Bilateral Procedure): Applied when the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 59 (Distinct Procedural Service): Indicates that the procedure is distinct or independent from other services performed on the same day. This is used to avoid bundling issues and to show that the procedures are not related.
5. Modifier 76 (Repeat Procedure by Same Physician): Applied when the same procedure is repeated by the same physician on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by a different physician on the same day.
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): Indicates that the patient required a return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was required during the procedure.
10. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required during the procedure.
11. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available.
12. Modifier 99 (Multiple Modifiers): Used when two or more modifiers are necessary to describe the service provided.
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 11446 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. Each MAC may have specific coverage policies and guidelines that can affect reimbursement.
For CPT code 11446, you would need to verify its inclusion and the associated reimbursement rate in the MPFS. Additionally, checking with your local MAC will provide further clarity on any regional variations or specific documentation requirements that could impact reimbursement. By cross-referencing both the MPFS and MAC guidelines, you can determine if CPT code 11446 is reimbursed by Medicare and understand any conditions or limitations that may apply.
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