CPT code 11450 is a medical billing code used for the removal of a sweat gland lesion.
CPT code 11450 is used for the surgical removal of a sweat gland lesion. This procedure involves excising a lesion that originates from the sweat glands, which are typically found in areas like the underarms, groin, or other parts of the body where sweat glands are prevalent. The code covers the complete removal of the lesion, including the necessary margins to ensure that no abnormal tissue remains. This is often done to treat conditions such as hidradenitis suppurativa or other sweat gland disorders that may cause discomfort or pose a risk of infection.
For CPT code 11450, which pertains to the removal of a sweat gland lesion, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure
- This modifier is used when the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider.
4. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used when the same procedure is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier when the same procedure is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician
- Use this modifier for an unplanned return to the operating/procedure room by the same physician following the initial procedure for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
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 GA - Waiver of Liability Statement Issued as Required by Payer Policy
- This modifier is used when a waiver of liability statement is issued as required by payer policy, indicating that the patient has been informed that the service may not be covered.
12. Modifier GC - Service Performed in Part by a Resident Under the Direction of a Teaching Physician
- Apply this modifier when a service is performed in part by a resident under the direction of a teaching physician.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11450 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for CPT code 11450.
It is essential for healthcare providers to consult both the MPFS and their respective MAC guidelines to ensure compliance and accurate reimbursement for this procedure.
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