CPT code 17004 is for the destruction of 15 or more premalignant lesions, typically through methods like cryotherapy or laser treatment.
CPT code 17004 is used to describe the procedure for destroying 15 or more premalignant lesions. This code is typically utilized by healthcare providers to document and bill for the removal of these lesions, which are abnormal skin growths that have the potential to become cancerous. The destruction can be performed using various methods such as cryotherapy, laser therapy, or other techniques. This code ensures that the provider is accurately compensated for the extensive work involved in treating multiple lesions in a single session.
For CPT code 17004, which involves the destruction of 15 or more premalignant lesions, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used when an E/M service is provided on the same day as the procedure, and the E/M service is above and beyond the usual preoperative and postoperative care associated with the procedure.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary to use this modifier if multiple procedures are performed that are not typically reported together.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used when a procedure or service is repeated by the same provider subsequent to the original procedure or service.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used when a procedure or service is repeated by a different provider subsequent to the original procedure or service.
5. Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period. This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial procedure.
6. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
7. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 17004 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the payment rates used by Medicare to reimburse physicians and other healthcare providers for services rendered.
CPT code 17004 is generally reimbursed by Medicare, but the exact reimbursement rate and any specific coverage criteria can vary based on the MAC's local coverage determinations (LCDs). It is advisable to review the MPFS for the most current reimbursement rates and consult your MAC for any additional requirements or documentation needed to ensure proper reimbursement for CPT code 17004.
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