CPT code 11623 is for the excision of malignant skin lesions on the face, ears, or scalp, measuring 2.1 to 3 cm, including margins.
CPT code 11623 is used to describe the excision of malignant skin lesions, including margins, on the face, ears, eyelids, nose, lips, or genitalia, with a lesion diameter of 2.1 to 3.0 centimeters. This code is specific to procedures where the surgeon removes cancerous skin growths in these sensitive areas, ensuring that the excision includes a margin of healthy tissue around the lesion to help ensure complete removal.
For CPT code 11623, which pertains to the 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. This modifier is used when an E/M service is provided on the same day as the procedure and is distinct from the procedure itself.
2. Modifier 50: Bilateral procedure. This modifier is used if the procedure is performed on both sides of the body.
3. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same surgical session.
4. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. This modifier is used if the procedure is planned or anticipated (staged) or more extensive than the original procedure.
5. 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.
6. Modifier 76: Repeat procedure or service by the same physician. This modifier is used when the same procedure is repeated by the same physician.
7. Modifier 77: Repeat procedure by another physician. This modifier is used when the same procedure is 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. This modifier is used for complications or other unplanned returns to the operating room.
9. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. This modifier is used when a procedure is performed during the postoperative period of another procedure, but is unrelated to the original procedure.
10. Modifier 90: Reference (outside) laboratory. This modifier is used when laboratory procedures are performed by a party other than the treating or reporting physician.
11. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used when a laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
12. Modifier 99: Multiple modifiers. This modifier is 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 11623 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 11623. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining local coverage and payment policies. Each MAC may have specific guidelines and reimbursement rates for CPT code 11623, so it is essential for providers to consult their respective MAC for precise information. This ensures that they are in compliance with local policies and receive accurate reimbursement for the services rendered.
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