CPT code 11646 is for the excision of malignant skin lesions on the face, ears, eyelids, nose, or lips, measuring over 4 cm, including margins.
CPT code 11646 is used to describe the surgical procedure for the excision of malignant skin lesions, including margins, on the face, ears, eyelids, nose, or lips, where the lesion is greater than 4 centimeters in size. This code is specific to cases where the lesion is large and located in sensitive or cosmetically significant areas, requiring precise and careful removal to ensure complete excision and optimal healing.
When using CPT code 11646, which pertains to the excision of a malignant lesion including margins, face, ears, eyelids, nose, or lips, with a lesion diameter greater than 4 cm, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as the complexity of the lesion or patient-specific factors.
2. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Apply this modifier if an evaluation and management (E/M) service was performed on the same day as the procedure and was distinct and separately identifiable from the procedure itself.
3. Modifier 50 (Bilateral Procedure): Use this modifier if the procedure was performed on both sides of the body during the same operative session.
4. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This indicates that the primary procedure was accompanied by additional procedures.
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. This could be due to different anatomical sites or separate patient encounters.
6. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Apply this modifier if the same procedure was repeated by the same provider on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Use this modifier if the same procedure was repeated by a different provider on the same day.
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): Apply this modifier if the patient required an unplanned return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier if an unrelated procedure was performed by the same provider during the postoperative period of the initial procedure.
10. Modifier 90 (Reference (Outside) Laboratory): Apply this modifier if laboratory procedures were performed by an outside laboratory.
11. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Use this modifier if a clinical diagnostic laboratory test was repeated for the same patient on the same day to obtain subsequent (multiple) test results.
12. Modifier 99 (Multiple Modifiers): Apply this modifier if more than four modifiers are necessary to describe the service provided. This indicates that multiple modifiers are being used to fully describe the procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11646 is reimbursed by Medicare, but the reimbursement is subject to the guidelines and rates set forth in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals.
Additionally, the reimbursement for CPT code 11646 may vary depending on the specific Medicare Administrative Contractor (MAC) that processes claims in your region. Each MAC has the authority to interpret Medicare policies and may have localized coverage determinations that can affect reimbursement.
Therefore, it is essential to verify the specific reimbursement details with your regional MAC to ensure compliance and accurate payment.
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 11646. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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