CPT code 11606 is for the excision of a malignant skin lesion, including margins, that is greater than 4 cm in size.
CPT code 11606 is used to describe the excision of a malignant skin lesion, including margins, that is greater than 4 centimeters in diameter. This code is specific to procedures where the lesion is located on the trunk, arms, or legs. It covers the surgical removal of the lesion along with a margin of normal tissue around it to ensure complete excision.
When using CPT code 11606, which pertains to the excision of a malignant lesion including margins, greater than 4 cm, 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 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Applied when a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
3. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both sides of the body.
4. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session.
5. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Used if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a diagnostic surgical procedure.
6. Modifier 59 (Distinct Procedural Service): 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): Applied when the same procedure is repeated by the same physician.
8. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Used when the same procedure is repeated by a different physician.
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): Applied when an unplanned return to the operating room is necessary for a related procedure during the postoperative period.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required for the procedure.
12. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
14. Modifier 99 (Multiple Modifiers): Used when 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 11606 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, the final determination of reimbursement for CPT code 11606 may also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can have localized policies that affect coverage and payment. Therefore, it is essential to consult both the MPFS and your regional MAC to confirm the reimbursement details for CPT code 11606.
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