CPT code 11971 is for the removal of tissue expander without insertion of an implant.
CPT code 11971 is used for the removal of a tissue expander without the insertion of an implant. This procedure typically occurs after a tissue expander, which is often used in reconstructive surgeries to stretch the skin, has served its purpose. The code indicates that the expander is being taken out, but no new implant is being placed at the same time.
For CPT code 11971 (Removal of tissue expander(s) without insertion of implant), 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.
2. Modifier 50 - Bilateral Procedure: Apply this modifier if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if the same procedure is repeated by a different physician.
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: Use this modifier 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: Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if 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: Apply this modifier when these non-physician practitioners assist in the surgery.
These modifiers help to provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11971, which stands for "Rmvl tis xpndr wo insj implt," is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes. Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm coverage and any regional variations in reimbursement policies. The MACs are responsible for processing Medicare claims and can provide the most accurate and up-to-date information regarding the reimbursement of CPT code 11971.
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