CPT code 17263 is for the destruction of skin lesions, a procedure to remove abnormal skin growths using various techniques.
CPT code 17263 is used for the destruction of malignant skin lesions on the face, ears, eyelids, nose, or lips, specifically when the lesion is between 2.1 to 5.0 cm in size. This code covers procedures that involve methods such as laser surgery, electrosurgery, cryosurgery, chemosurgery, or surgical curettement to remove the lesion.
For CPT code 17263, 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. This modifier is used when an E/M service is provided on the same day as the procedure and is distinct from the procedure itself.
2. Modifier 50: Bilateral procedure. This modifier is used when the procedure is performed on both sides of the body.
3. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same session.
4. 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.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used when the same procedure is repeated on the same day by the same provider.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when the same procedure is 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. This modifier is used when the patient needs to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. This modifier is used when an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
9. Modifier LT: Left side. This modifier is used to indicate that the procedure was performed on the left side of the body.
10. Modifier RT: Right side. This modifier is used 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. This modifier is used when an Advance Beneficiary Notice (ABN) is on file.
12. Modifier GX: Notice of liability issued, voluntary under payer policy. This modifier is used when a voluntary ABN was issued for a service.
13. Modifier GY: Item or service statutorily excluded, does not meet the definition of any Medicare benefit. This modifier is used when the service is not covered by Medicare.
14. Modifier GZ: Item or service expected to be denied as not reasonable and necessary. This modifier is used when an ABN was not issued, and the service is expected to be denied.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 17263 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and these rates can vary based on geographic location and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for CPT code 17263. Providers should consult their respective MACs to understand any regional variations or additional documentation requirements that may apply to ensure proper reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, including specific codes like 17263. Don't let underpayments slip through the cracks—schedule a demo today to see how RevFind can optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
