CPT code 11771 is for the surgical removal of a pilonidal cyst, including extensive cleaning and closure of the wound.
CPT code 11771 is used to describe the surgical procedure for the removal of a pilonidal cyst, which includes extensive excision. This code is specifically for cases where the cyst is more complex and requires a more thorough and detailed removal process. The procedure involves excising the cyst along with any surrounding tissue that may be affected, ensuring that the area is properly cleaned and treated to prevent recurrence. This code is typically used by healthcare providers to accurately document and bill for the extensive surgical removal of a pilonidal cyst.
When billing for CPT code 11771, which pertains to the removal of a pilonidal cyst with extensive excision, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to perform the procedure is substantially greater than typically required. For example, if the removal of the pilonidal cyst involves extensive dissection or additional time due to complications, Modifier 22 would be appropriate.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed bilaterally, Modifier 50 should be appended to indicate that the service was provided on both sides of the body.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, Modifier 51 is used to indicate that multiple services were provided.
4. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used if the removal of the pilonidal cyst is part of a staged or related procedure during the postoperative period of the initial surgery.
5. Modifier 59 (Distinct Procedural Service): Modifier 59 is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is particularly relevant if another procedure is performed that is not typically bundled with the removal of the pilonidal cyst.
6. Modifier 62 (Two Surgeons): If two surgeons are required to perform the procedure due to its complexity, Modifier 62 should be used to indicate that both surgeons were necessary for the successful completion of the surgery.
7. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used if the same physician needs to repeat the removal of a pilonidal cyst within a short period due to recurrence or incomplete removal.
8. Modifier 77 (Repeat Procedure by Another Physician): If a different physician needs to repeat the procedure, Modifier 77 should be used.
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): This modifier is used if the patient needs to 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): If an unrelated procedure is performed by the same physician during the postoperative period, Modifier 79 should be used.
11. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required to help with the procedure, Modifier 80 should be appended.
12. Modifier 81 (Minimum Assistant Surgeon): This modifier is used if a minimum assistant surgeon is required for the procedure.
13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): If an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon, Modifier 82 should be used.
14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
The CPT code 11771 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 11771. However, the actual reimbursement amount may differ depending on the region and the Medicare Administrative Contractor (MAC) overseeing the claims in that area.
Each MAC has the authority to interpret Medicare policies and set local coverage determinations, which can influence the reimbursement process for CPT code 11771. Therefore, it is essential to consult the MPFS and the relevant MAC guidelines to determine the exact reimbursement details for this code.
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