CPT code 11602 is for the excision of a malignant skin lesion with margins, measuring 1.1 to 2 cm.
CPT code 11602 is used to describe the excision of a malignant skin lesion, including the margins, with a diameter of 1.1 to 2 centimeters. This code is specifically for procedures where the lesion is removed from areas such as the trunk, arms, or legs.
When using CPT code 11602, which pertains to the excision of a malignant lesion including margins, with a diameter of 1.1 to 2.0 cm, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. For example, if the lesion is in a difficult location or if there are complications that require additional time and effort.
2. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): This modifier is used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the procedure.
3. Modifier 50 (Bilateral Procedure): This modifier is used if the procedure is performed on both sides of the body.
4. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures, other than E/M services, are performed at the same session by the same provider.
5. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
6. 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.
7. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): This modifier is used if the same procedure is repeated by the same physician or other qualified healthcare professional.
8. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): This modifier is used if the same procedure is repeated by a different physician or other qualified healthcare professional.
9. 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 if the patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if an unrelated procedure or service is performed by the same physician during the postoperative period.
11. Modifier 90 (Reference (Outside) Laboratory): This modifier is used if laboratory procedures are performed by a party other than the treating or reporting physician.
12. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): This modifier is used if a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
13. Modifier 99 (Multiple Modifiers): This modifier is used if two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 11602 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 11602. However, the actual reimbursement may differ depending on the geographic location and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in that region. Each MAC may have slightly different policies and rates, so it is essential to check with the local MAC for the most accurate and up-to-date reimbursement information for CPT code 11602.
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