CPT code 11451 is for the removal of a sweat gland lesion, a procedure often performed to treat conditions like hidradenitis suppurativa.
CPT code 11451 is used to describe the surgical procedure for the removal of a sweat gland lesion. This code is specifically assigned to indicate that a healthcare provider has performed an excision to remove abnormal or problematic sweat glands, which could be causing issues such as excessive sweating or infection. The procedure typically involves making an incision to access and remove the affected sweat glands, ensuring that the surrounding tissue is minimally impacted. This code helps in accurately documenting the service provided for billing and insurance purposes.
For CPT code 11451, which pertains to the removal of a sweat gland lesion, 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 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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 by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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: Used when a related procedure is performed during the postoperative period.
9. 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.
10. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the body.
12. Modifier XS - Separate Structure: Used to indicate a service that is distinct because it was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter: Used to indicate a service that is distinct because it occurred during a separate encounter.
14. Modifier XP - Separate Practitioner: Used to indicate a service that is distinct because it was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service: Used to indicate a service that is distinct because it does not overlap usual components of the main service.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement.
The CPT code 11451 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs can offer localized guidance and any specific documentation requirements or coverage limitations that may apply to CPT code 11451.
Always ensure to check the latest updates and guidelines from both the MPFS and your MAC to confirm the reimbursement status and any pertinent billing instructions.
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