CPT code 11770 is for the simple removal of a pilonidal cyst, a procedure often performed to treat this type of skin infection.
CPT code 11770 is used to describe the medical procedure for the simple removal of a pilonidal cyst. This code is specifically assigned to indicate that the cyst, which typically occurs near the tailbone and can become infected or cause discomfort, is being excised in a straightforward manner without complications. This procedure is generally performed in an outpatient setting and involves the surgical removal of the cyst to prevent further issues.
When billing for the removal of a pilonidal cyst (simple), CPT code 11770 may require the use of specific modifiers to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 11770, along with the reasons for their use:
1. Modifier -22 (Increased Procedural Services)
- Used when 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 -50 (Bilateral Procedure)
- Used if the procedure is performed on both sides of the body. This is less common for this specific procedure but could be applicable in rare cases.
3. Modifier -51 (Multiple Procedures)
- Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier -52 (Reduced Services)
- Used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction in services.
5. Modifier -59 (Distinct Procedural Service)
- Used to indicate 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.
6. Modifier -76 (Repeat Procedure by Same Physician)
- Used when the same procedure is repeated by the same physician on the same day. Documentation should support the medical necessity for the repeat procedure.
7. Modifier -77 (Repeat Procedure by Another Physician)
- Used when the same procedure is repeated by a different physician on the same day. Documentation should support the medical necessity for the repeat procedure.
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)
- Used when a related procedure is performed during the postoperative period of the initial procedure. This indicates that the return to the operating room was unplanned.
9. 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. This indicates that the new procedure is not related to the initial surgery.
10. Modifier -80 (Assistant Surgeon)
- Used when an assistant surgeon is required for the procedure. This modifier indicates that another surgeon assisted in the procedure.
11. Modifier -81 (Minimum Assistant Surgeon)
- Used when a minimum assistant surgeon is required for the procedure. This indicates that the assistance was minimal but necessary.
12. Modifier -82 (Assistant Surgeon (when qualified resident surgeon not available))
- Used when an assistant surgeon is required because a qualified resident surgeon was not available. This is often used in teaching hospitals.
13. Modifier -99 (Multiple Modifiers)
- Used when more than four modifiers are necessary to describe the service. This indicates that multiple modifiers are applicable and should be listed in the documentation.
Each of these modifiers provides specific information that can affect the billing and reimbursement process, ensuring that the claim accurately reflects the services provided. Proper use of modifiers is crucial for compliance and optimal reimbursement.
The CPT code 11770, which involves the removal of a pilonidal cyst in a simple manner, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for various medical services covered by Medicare. Additionally, it is important to consult with the specific Medicare Administrative Contractor (MAC) for your region, as they administer Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 11770.
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 11770. Schedule a demo today to see how RevFind can help you identify and recover lost revenue from individual payers.
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