CPT code 17262 is used for the medical procedure involving the destruction of skin lesions.
CPT code 17262 is used to describe the procedure for the destruction of malignant skin lesions on the face, ears, eyelids, nose, or lips. This code specifically applies to lesions that are between 1.1 cm and 2.0 cm in size. The destruction can be achieved through various methods such as laser surgery, electrosurgery, cryosurgery, or chemical treatment. This code ensures that healthcare providers can accurately document and bill for the removal of these specific types of skin lesions, facilitating proper reimbursement and record-keeping.
When using CPT code 17262 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 skin lesions.
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 during the postoperative period.
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 the original procedure performed during the postoperative period.
9. Modifier 90: Reference (outside) laboratory. Use this modifier if the destruction of skin lesions involved sending specimens to an outside laboratory for analysis.
10. Modifier 91: Repeat clinical diagnostic laboratory test. Use this modifier if the destruction of skin lesions required repeat laboratory tests on the same day.
11. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. Use this modifier if the destruction of skin lesions was planned or discussed during a telemedicine consultation.
12. Modifier XE: Separate encounter. Use this modifier to indicate that the destruction of skin lesions was performed during a separate encounter on the same day.
13. Modifier XS: Separate structure. Use this modifier to indicate that the destruction of skin lesions was performed on a separate organ/structure.
14. Modifier XP: Separate practitioner. Use this modifier to indicate that the destruction of skin lesions was performed by a different practitioner.
15. Modifier XU: Unusual non-overlapping service. Use this modifier to indicate that the destruction of skin lesions was a distinct, non-overlapping service from other procedures performed on the same day.
These modifiers help provide additional information about the circumstances under which the destruction of skin lesions was performed, ensuring accurate billing and reimbursement.
When determining if CPT code 17262 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 services, and it is updated annually.
To verify if CPT code 17262 is reimbursed, you would need to check the MPFS for the current year. Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims, may have specific local coverage determinations (LCDs) that could affect reimbursement.
Therefore, to confirm if CPT code 17262 is reimbursed by Medicare, you should review the MPFS and consult with your regional MAC for any specific coverage guidelines or restrictions.
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