CPT code 11620 is for the excision of malignant skin lesions on the head, face, neck, or scalp with margins of 0.5 cm or less.
CPT code 11620 is used to describe the excision of malignant skin lesions, including the margins, on the head, face, neck, hands, feet, and genitalia, with a lesion diameter of 0.5 centimeters or less. This code is specific to procedures where the surgeon removes both the cancerous lesion and a small margin of surrounding healthy tissue to ensure complete excision.
For CPT code 11620, which pertains to the excision of malignant skin lesions with margins of 0.5 cm or less, 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 for a related procedure.
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 and performed during the postoperative period.
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 test results.
12. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. Use this modifier if the service was provided through telemedicine.
13. Modifier LT: Left side. Use this modifier if the procedure was performed on the left side of the body.
14. Modifier RT: Right side. Use this modifier if the procedure was performed on the right side of the body.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11620 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, and it is essential to verify the current rates and guidelines as they can change annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for CPT code 11620. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and payment policies. Therefore, it is advisable to consult the relevant MAC for your region to ensure compliance with local coverage determinations and to confirm the reimbursement details for CPT code 11620.
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