CPT code 11642 is for the excision of a malignant skin lesion on the face, ears, eyelids, nose, or lips, measuring 1.1 to 2.0 cm.
CPT code 11642 is used to describe the excision of malignant skin lesions, including margins, on the face, ears, eyelids, nose, or lips, with a lesion diameter of 1.1 to 2.0 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 11642, which pertains to the excision of malignant skin lesions, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Use this modifier if 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): Use this modifier if the procedure is performed on both sides of the body during the same operative session.
4. Modifier 51 (Multiple Procedures): Use this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider.
5. 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 (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
6. 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.
7. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Use this modifier if the procedure is repeated by the same physician or other qualified healthcare professional.
8. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Use this modifier if the procedure is repeated by a different physician or other qualified healthcare professional.
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): Use this modifier if the patient returns 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): Use this modifier if an unrelated procedure or service is performed by the same physician during the postoperative period.
11. Modifier 90 (Reference (Outside) Laboratory): Use this modifier if laboratory procedures are performed by a party other than the treating or reporting physician.
12. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Use this modifier if a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
13. Modifier 99 (Multiple Modifiers): Use this modifier if two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
The CPT code 11642 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and practice costs.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your region to confirm the exact reimbursement rates and any specific guidelines that may apply to CPT code 11642.
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