CPT code 11603 is for the excision of a malignant skin lesion, including margins, measuring 2.1 to 3 cm.
CPT code 11603 is used to describe the excision of a malignant skin lesion, including margins, that measures between 2.1 to 3 centimeters in diameter. This code is specific to procedures where the lesion is located on the trunk, arms, or legs. The code ensures that the healthcare provider is accurately reimbursed for the complexity and extent of the excision procedure.
For CPT code 11603, which pertains to excision of malignant skin lesions with margins, 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 procedure.
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 procedure was planned or anticipated at the time of the original procedure.
5. Modifier 59: Distinct procedural service. Use this modifier to indicate that a procedure or service 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 by the same physician.
7. Modifier 77: Repeat procedure by another physician. Use this modifier if the same procedure was repeated by a different physician.
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 procedure was unrelated to the original procedure.
10. Modifier 90: Reference (outside) laboratory. Use this modifier if laboratory procedures were performed by a party other than the treating or reporting physician.
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 (multiple) test results.
12. Modifier 99: Multiple modifiers. Use this modifier if more than four modifiers are necessary to describe the service.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and appropriate reimbursement.
The CPT code 11603 is reimbursed by Medicare, but the reimbursement rate can vary based on several factors.
The Medicare Physician Fee Schedule (MPFS) provides the standardized payment rates for services covered by Medicare, including CPT code 11603.
However, the actual reimbursement amount may differ depending on the region and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in that area.
Each MAC may have slightly different policies and rates, so it is essential to consult the local MAC's guidelines and the MPFS to determine the exact reimbursement details for CPT code 11603.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 11603. Schedule a demo today to see how RevFind can identify discrepancies by individual payer and help you maximize your revenue.
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