CPT code 11601 is for the excision of a malignant skin lesion, including margins, measuring 0.6 to 1 cm.
CPT code 11601 is used to describe the excision of a malignant skin lesion, including the margins, with a diameter of 0.6 to 1.0 centimeters. This code is specifically for procedures where the lesion is located on the trunk, arms, or legs. It ensures that the healthcare provider is accurately documenting and billing for the removal of skin cancer within the specified size range.
For CPT code 11601, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the excision.
2. Modifier 50: Bilateral procedure. Use this modifier if the procedure was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. Use this modifier if the excision is part of a planned series of procedures.
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 or service by the same physician. Use this modifier if the same procedure was repeated on the same day.
7. Modifier 77: Repeat procedure by another physician. Use this modifier if the procedure was repeated by a different physician on the same day.
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. Use this modifier if the patient had to return to the operating room unexpectedly.
9. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the excision is unrelated to the original procedure.
10. Modifier 90: Reference (outside) laboratory. Use this modifier if the laboratory services were performed by an outside lab.
11. Modifier 91: Repeat clinical diagnostic laboratory test. Use this modifier if the same laboratory test was repeated on the same day to obtain subsequent results.
12. Modifier 99: Multiple modifiers. Use this modifier if more than four modifiers are needed to describe the service.
Each of these modifiers serves a specific purpose and should be used according to the clinical scenario and payer guidelines to ensure accurate billing and reimbursement.
When determining if CPT code 11601 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the relevant Medicare Administrative Contractor (MAC) for your region. The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates.
CPT code 11601 is generally reimbursed by Medicare, but the exact reimbursement can vary based on geographic location and other factors. The MAC for your region will have the most specific and up-to-date information regarding coverage and reimbursement rates for CPT code 11601. It is advisable to verify with your local MAC to ensure compliance and accurate billing.
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