CPT code 11624 is for the excision of skin, subcutaneous tissue, and fascia for malignant lesions, including margins, measuring 3.1 to 4 cm.
CPT code 11624 is used to describe the excision of a malignant skin lesion, including margins, on the face, ears, eyelids, nose, or lips, with the lesion size being between 3.1 to 4.0 centimeters. This code is specifically for procedures where the surgeon removes both the cancerous lesion and a margin of surrounding healthy tissue to ensure complete excision.
For CPT code 11624, which involves 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 factors such as increased complexity or time.
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. This helps in indicating that multiple services were provided.
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): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
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): Indicates an unplanned return to the operating room 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 (multiple) test results.
13. Modifier 99 (Multiple Modifiers): Indicates that multiple modifiers are applicable to the procedure. This is used when more than four modifiers are necessary to describe the service.
These modifiers help in providing additional information about the performed procedure, ensuring accurate billing and reimbursement.
The CPT code 11624 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. To determine the specific reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, the reimbursement may be subject to local adjustments and policies set by the Medicare Administrative Contractor (MAC) for the provider's specific region. It is essential to consult the MPFS and the relevant MAC guidelines to obtain accurate and up-to-date information on the reimbursement for CPT code 11624.
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