CPT code 17261 is for the destruction of skin lesions, a procedure used to remove abnormal skin growths through various methods.
CPT code 17261 is used to describe the procedure for the destruction of skin lesions. This code specifically refers to the removal of benign (non-cancerous) or premalignant (potentially cancerous) skin growths using methods such as laser surgery, cryosurgery (freezing), electrosurgery (using electric currents), or chemical treatment. The goal of this procedure is to eliminate the abnormal tissue to prevent further complications or to improve the patient's skin health and appearance.
When using CPT code 17261 for the destruction of skin lesions, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
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 destruction of the skin lesion.
2. Modifier 50: Bilateral procedure. Use this modifier if the destruction of skin lesions was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures, including the destruction of skin lesions, were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the destruction of skin lesions was a distinct service from other procedures performed on the same day.
5. Modifier 76: Repeat procedure or service by the same physician. Use this modifier if the destruction of skin lesions was repeated on the same day by the same physician.
6. Modifier 77: Repeat procedure by another physician. Use this modifier if the destruction of skin lesions was repeated on the same day by a different physician.
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 additional destruction of skin lesions related to the initial procedure.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the destruction of skin lesions was unrelated to a procedure performed during the postoperative period of another surgery.
9. Modifier LT: Left side. Use this modifier if the destruction of skin lesions was performed on the left side of the body.
10. Modifier RT: Right side. Use this modifier if the destruction of skin lesions was performed on the right side of the body.
11. Modifier XS: Separate structure. Use this modifier to indicate that the destruction of skin lesions was performed on a separate structure from other procedures on the same day.
12. Modifier XE: Separate encounter. Use this modifier if the destruction of skin lesions was performed during a separate encounter on the same day as other procedures.
13. Modifier XP: Separate practitioner. Use this modifier if the destruction of skin lesions was performed by a different practitioner on the same day as other procedures.
14. Modifier XU: Unusual non-overlapping service. Use this modifier to indicate that the destruction of skin lesions was an unusual, non-overlapping service distinct from other procedures performed on the same day.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
When determining if CPT code 17261 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 payment rates used by Medicare to reimburse physicians and other healthcare providers for services rendered. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular CPT code is reimbursed.
For CPT code 17261, you would first check the MPFS to see if it is listed and what the reimbursement rate is. Additionally, reviewing the LCDs from your MAC will provide further clarity on any specific conditions or documentation requirements needed for reimbursement. If CPT code 17261 is included in the MPFS and meets the criteria set forth by your MAC, it is likely to be reimbursed by Medicare.
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