CPT code 11970 is used for the replacement of a tissue expander with a permanent implant in medical procedures.
CPT code 11970 is used for the procedure of replacing a tissue expander with a permanent implant. This code is typically utilized in reconstructive surgeries, such as those following mastectomies, where a temporary tissue expander is initially placed to stretch the skin and create space for a future permanent implant. The CPT code 11970 specifically covers the surgical process of removing the expander and inserting the permanent implant, marking a significant step in the patient's reconstructive journey.
When using CPT code 11970, "Replacement of tissue expander with permanent implant," the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure
- Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same surgical session.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Used if the procedure is planned or staged during the postoperative period of the initial procedure.
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.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when the procedure is repeated by the same physician or other qualified healthcare professional.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when the procedure is repeated by a different physician or other qualified healthcare professional.
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 if the patient returns 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
- Used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11970, which stands for "Rplcmt tiss xpndr perm implt," is reimbursed by Medicare, but it is subject to specific guidelines and conditions.
Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided by physicians and other healthcare professionals.
Additionally, the reimbursement may vary based on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region.
Each MAC has the authority to implement local coverage determinations (LCDs) that can affect whether and how a particular CPT code is reimbursed.
Therefore, it is crucial to consult the MPFS and your specific MAC's guidelines to ensure compliance and proper reimbursement for CPT code 11970.
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 11970. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
