CPT code 11622 is for the excision of a malignant skin lesion, including margins, on the face, ears, eyelids, nose, or lips, measuring 1.1 to 2 cm.
CPT code 11622 is used to describe the excision (removal) of a malignant skin lesion, including margins, on the scalp, neck, hands, feet, or genitalia, with the lesion size being between 1.1 to 2.0 centimeters. This code is specific to procedures where the lesion is malignant and the excision includes a margin of normal tissue around the lesion to ensure complete removal.
For CPT code 11622, which pertains to the excision of malignant skin lesions with margins, 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 increased complexity or difficulty of the procedure.
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 during the same operative session.
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 a subsequent procedure is planned or staged during the postoperative period of the initial 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 of the initial procedure.
11. Modifier 90 - Reference (Outside) Laboratory
- Applied when laboratory procedures are performed by a party other than the treating or reporting physician.
12. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
- Used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent test results.
13. Modifier 99 - Multiple Modifiers
- Applied when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the performed procedure, ensuring accurate billing and appropriate reimbursement.
Determining if CPT code 11622 is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and consulting with your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates.
To verify if CPT code 11622 is reimbursed, you should first look it up in the MPFS database. Additionally, since MACs administer Medicare claims and can have regional variations in coverage, it is crucial to consult your specific MAC for any local coverage determinations (LCDs) that might affect reimbursement for CPT code 11622.
This dual approach ensures that you have the most accurate and region-specific information regarding Medicare reimbursement for this particular code.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 11622. Schedule a demo today to see how RevFind can help you recover lost revenue from individual payers.
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