CPT code 11640 is for the excision of a malignant lesion on the face, ears, eyelids, nose, or lips, measuring less than 0.5 cm.
CPT code 11640 is used to describe the excision of a malignant skin lesion, including margins, on the face, ears, eyelids, nose, or lips, with a lesion diameter of less than 0.5 centimeters. This code is specific to procedures where the lesion is small and located in these sensitive and cosmetically significant areas.
For CPT code 11640, which involves excision of malignant skin lesions, 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 prospectively or at the time of the original procedure.
5. Modifier 59: Distinct procedural service. Use this modifier to indicate that the procedure 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 procedure was repeated by the same physician.
7. Modifier 77: Repeat procedure by another physician. Use this modifier if the 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.
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 (multiple) 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 to indicate that the procedure was performed on the left side of the body.
14. Modifier RT: Right side. Use this modifier to indicate that the procedure was performed on the right side of the body.
15. Modifier XS: Separate structure. Use this modifier to indicate that a service was performed on a separate organ/structure.
16. Modifier XE: Separate encounter. Use this modifier to indicate that a service was performed during a separate encounter.
17. Modifier XP: Separate practitioner. Use this modifier to indicate that a service was performed by a different practitioner.
18. Modifier XU: Unusual non-overlapping service. Use this modifier to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information about the performed procedure and ensure accurate billing and reimbursement.
The CPT code 11640 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 covered by Medicare, and it is essential to verify the specific rate and any associated guidelines for CPT code 11640.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for this code. MACs are responsible for processing Medicare claims and may have local coverage determinations (LCDs) that affect the reimbursement of CPT code 11640. Therefore, it is advisable to consult the relevant MAC for your region to ensure compliance with any local policies and to confirm the exact reimbursement details for this CPT code.
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