CPT code 17266 is for the destruction of skin lesions. It covers procedures to remove abnormal skin growths using various techniques.
CPT code 17266 is used for the destruction of malignant skin lesions on the face, ears, eyelids, nose, or lips, using methods such as laser surgery, electrosurgery, cryosurgery, chemosurgery, or surgical curettement. This code specifically applies to lesions that are greater than 2.0 cm in diameter. The procedure aims to remove cancerous growths and prevent their spread or recurrence.
For CPT code 17266, which pertains to the destruction of skin lesions, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could be due to the size, number, or location of the lesions.
2. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Applied when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the procedure.
3. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both sides of the body.
4. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same session.
5. Modifier 52 (Reduced Services): Used when the service provided is less extensive than described in the CPT code.
6. Modifier 59 (Distinct Procedural Service): Applied to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Used when the same procedure is repeated by the same physician.
8. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Applied when the same procedure is repeated by a different physician.
9. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Used when a patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 90 (Reference (Outside) Laboratory): Used when laboratory procedures are performed by a party other than the treating or reporting physician.
12. Modifier 91 (Repeat Clinical Diagnostic Laboratory Test): Applied when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
13. Modifier 99 (Multiple Modifiers): Used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 17266 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and pricing.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, healthcare providers should consult the MPFS and their respective MAC to determine the exact reimbursement rate and any specific billing requirements for CPT code 17266.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. For instance, if you're seeing discrepancies in payments for CPT code 17266, RevFind can pinpoint these issues with precision. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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
