CPT code 11462 is for the removal of a sweat gland lesion, a procedure often performed to treat conditions like hidradenitis suppurativa.
CPT code 11462 is used to describe the surgical procedure for the removal of a sweat gland lesion. This code specifically refers to the excision of a benign lesion from the skin, which involves cutting out the lesion along with a margin of surrounding tissue to ensure complete removal. This procedure is typically performed 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 11462, 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.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier should be used.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier should be used.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician.
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: This modifier is used when a related procedure is performed during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used if an unrelated procedure is performed during the postoperative period.
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 XS - Separate Structure: This modifier is used to indicate that a service was performed on a separate organ/structure.
12. Modifier XE - Separate Encounter: Use this modifier to indicate that a service was performed during a separate encounter.
13. Modifier XP - Separate Practitioner: This modifier is used to indicate that a service was performed by a different practitioner.
14. Modifier XU - Unusual Non-Overlapping Service: Use this modifier to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11462 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 their corresponding reimbursement rates.
Additionally, the reimbursement for CPT code 11462 may vary depending on the policies of the Medicare Administrative Contractor (MAC) that oversees the specific geographic region where the service is provided. Each MAC has the authority to implement local coverage determinations (LCDs) that can affect whether and how a particular CPT code is reimbursed.
Therefore, it is essential for healthcare providers to consult both the MPFS and their respective MAC's guidelines to ensure proper reimbursement for CPT code 11462.
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