CPT code 17271 is for the destruction of skin lesions, a procedure involving the removal of abnormal skin growths using various techniques.
CPT code 17271 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 when the lesion being treated is between 0.5 cm and 1.0 cm in size. The destruction can be achieved through various methods such as laser surgery, electrosurgery, cryosurgery, or chemical treatment. This code ensures that the healthcare provider is accurately reimbursed for the specific type and size of the lesion treated.
When using CPT code 17271 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 on the same day as the destruction of skin lesions and is distinct from the procedure itself.
2. Modifier 50: Bilateral procedure.
- Apply this modifier if the destruction of skin lesions was performed on both sides of the body during the same session.
3. Modifier 51: Multiple procedures.
- Use this modifier when multiple procedures, including the destruction of skin lesions, are performed during the same session by the same provider.
4. Modifier 59: Distinct procedural service.
- This modifier is used to indicate that the destruction of skin lesions was a distinct procedural service from other services provided on the same day.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional.
- Apply this modifier if the destruction of skin lesions was repeated by the same provider on the same day.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional.
- Use this modifier if the destruction of skin lesions was repeated by a different provider on the same day.
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 applicable if the patient had to return for an additional destruction of skin lesions related to the initial procedure 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 is unrelated to the original procedure and occurs during the postoperative period of another procedure.
9. Modifier 90: Reference (outside) laboratory.
- Apply 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 a clinical diagnostic laboratory test related to the destruction of skin lesions needs to be repeated on the same day.
11. Modifier LT: Left side.
- Apply this modifier if the destruction of skin lesions was performed on the left side of the body.
12. Modifier RT: Right side.
- Use this modifier if the destruction of skin lesions was performed on the right side of the body.
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 17271 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the maximum fees Medicare will pay for various services, and it is updated annually. Each MAC may have specific local coverage determinations (LCDs) that can affect reimbursement.
To verify if CPT code 17271 is reimbursed, you should:
1. Check the MPFS: Access the latest MPFS to see if CPT code 17271 is listed and review the associated reimbursement rates.
2. Consult Your MAC: Each MAC may have unique policies and guidelines. Reviewing the LCDs and other relevant documentation from your MAC will provide clarity on whether CPT code 17271 is covered and any specific conditions that must be met for reimbursement.
By following these steps, you can determine if CPT code 17271 is reimbursed by Medicare.
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