CPT code 17260 is for the destruction of skin lesions, a procedure to remove abnormal skin growths using various methods.
CPT code 17260 is used to describe the medical procedure for the destruction of benign skin lesions. This code specifically applies to the treatment of lesions that are not cancerous and are typically removed through methods such as cryotherapy (freezing), laser therapy, or other techniques that destroy the lesion tissue. This procedure is often performed to remove unsightly or bothersome skin growths, ensuring they do not cause further irritation or complications.
When billing for CPT code 17260, which pertains to the destruction of skin lesions, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the procedure.
2. Modifier 50: Bilateral procedure. Use this modifier if the procedure was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the procedure was repeated on the same day.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the procedure was repeated on the same day by a different provider.
7. 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 had to return for an additional procedure related to the initial one.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the procedure is unrelated to the original procedure and performed during the postoperative period.
9. Modifier LT: Left side. Use this modifier to indicate that the procedure was performed on the left side of the body.
10. Modifier RT: Right side. Use this modifier to indicate that the procedure was performed on the right side of the body.
11. Modifier GA: Waiver of liability statement issued as required by payer policy, individual case. Use this modifier if an Advance Beneficiary Notice (ABN) was issued for a service that might not be covered.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. Use this modifier if a voluntary ABN was issued for a service that is not covered.
13. Modifier GY: Item or service statutorily excluded or does not meet the definition of any Medicare benefit. Use this modifier if the service is not covered by Medicare.
14. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. Use this modifier if no ABN was issued and the service is expected to be denied.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements.
When determining if CPT code 17260 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various healthcare services, including procedures and treatments.
CPT code 17260 is generally reimbursed by Medicare, but the reimbursement rate and specific coverage criteria can vary based on the MAC's local coverage determinations (LCDs). These LCDs outline the conditions under which a service is considered medically necessary and, therefore, eligible for reimbursement.
To ensure accurate reimbursement, healthcare providers should verify the specific requirements and guidelines set forth by their regional MAC and review the MPFS for the most current reimbursement rates and policies related to CPT code 17260.
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