CPT code 11470 is for the removal of a sweat gland lesion, a procedure often performed to treat conditions like hidradenitis suppurativa.
CPT code 11470 is used to describe the procedure for the removal of a sweat gland lesion. This code is specifically assigned to the surgical excision of abnormal or problematic sweat glands, which may be necessary due to conditions such as hidradenitis suppurativa or other sweat gland disorders. The procedure involves the careful removal of the affected tissue to alleviate symptoms and prevent further complications.
For CPT code 11470, "Removal of sweat gland lesion," the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more effort or time than usual.
2. Modifier 50 (Bilateral Procedure): Apply this modifier if the procedure was performed on both sides of the body.
3. Modifier 51 (Multiple Procedures): Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 52 (Reduced Services): This modifier is appropriate if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 (Repeat Procedure by Same Physician): Apply this modifier if the same procedure was repeated by the same physician.
7. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if the procedure was repeated by a different physician.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room): This modifier is used if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
10. Modifier LT (Left Side): Use this modifier to specify that the procedure was performed on the left side of the body.
11. Modifier RT (Right Side): Use this modifier to specify that the procedure was performed on the right side of the body.
12. Modifier GA (Waiver of Liability Statement Issued as Required by Payer Policy): This modifier is used when an Advance Beneficiary Notice (ABN) is on file.
13. Modifier GC (Service Performed in Part by a Resident Under the Direction of a Teaching Physician): Apply this modifier if the service was performed by a resident under the supervision of a teaching physician.
14. Modifier QX (CRNA Service with Medical Direction by a Physician): Use this modifier if the procedure involved a Certified Registered Nurse Anesthetist (CRNA) under the medical direction of a physician.
15. Modifier QY (Medical Direction of One CRNA by an Anesthesiologist): Apply this modifier if an anesthesiologist provided medical direction for one CRNA.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11470, which pertains to the removal of a sweat gland lesion, is reimbursed by Medicare. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various CPT codes, including 11470. Additionally, it is important to consult with your local Medicare Administrative Contractor (MAC) as they can provide region-specific information and any potential variations in reimbursement policies.
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