CPT code 11471 is for the removal of a sweat gland lesion, a procedure often performed to treat conditions like hidradenitis suppurativa.
CPT code 11471 is used for the surgical removal of a sweat gland lesion. This procedure involves excising a lesion that originates from the sweat glands, which may be necessary due to various medical conditions such as hidradenitis suppurativa or other sweat gland disorders. The code ensures that the healthcare provider is accurately reimbursed for the specific service of removing these types of lesions.
For CPT code 11471, 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. This could be due to the complexity of the lesion or the patient's condition.
2. Modifier 50 - Bilateral Procedure: Applied if 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 removal of the sweat gland lesion is one of several procedures.
4. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day. This could be used if the removal of the sweat gland lesion is performed in a different anatomical site or through a separate incision.
5. Modifier 76 - Repeat Procedure by Same Physician: Applied if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Used if 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: This could be used if complications arise that necessitate a return to the operating room.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the removal of the sweat gland lesion is unrelated to the original procedure performed during the postoperative period.
9. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the body.
10. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the body.
11. Modifier XS - Separate Structure: Indicates that a service is distinct because it was performed on a separate organ/structure.
12. Modifier XP - Separate Practitioner: Indicates that a service is distinct because it was performed by a different practitioner.
13. Modifier XE - Separate Encounter: Indicates that a service is distinct because it was performed during a separate encounter.
14. Modifier XU - Unusual Non-Overlapping Service: Indicates that a service is distinct because it 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 11471 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.
Additionally, reimbursement for CPT code 11471 may vary based on the policies of the Medicare Administrative Contractor (MAC) in your region. Each MAC has the authority to interpret Medicare guidelines and set local coverage determinations, which can influence whether and how a particular service is reimbursed.
Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 11471.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 11471. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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