CPT code 17272 is for the destruction of skin lesions, which involves removing abnormal skin growths using various techniques.
CPT code 17272 is used to describe the medical procedure for the destruction of skin lesions. This code specifically refers to the treatment of benign or premalignant skin growths using methods such as laser surgery, electrosurgery, cryosurgery, or chemical treatment. The goal of this procedure is to remove unwanted or potentially harmful skin lesions to prevent further complications or to improve the patient's skin health.
When using CPT code 17272 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 22 (Increased Procedural Services): Use this modifier if the procedure required significantly greater effort 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): Apply this modifier if an evaluation and management (E/M) service was performed on the same day as the procedure and was significant and separately identifiable from the destruction of the skin lesions.
3. Modifier 50 (Bilateral Procedure): Use this modifier if the procedure was performed on both sides of the body.
4. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same session. This is relevant if other procedures were performed in addition to the destruction of skin lesions.
5. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the destruction of skin lesions was a distinct procedural service from other services performed on the same day.
6. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Apply this modifier if the same procedure was repeated by the same provider on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Use this modifier if the same procedure was repeated by a different provider on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT (Left Side): Apply this modifier if the procedure was performed on the left side of the body.
11. Modifier RT (Right Side): Use this modifier if the procedure was performed on the right side of the body.
12. Modifier GA (Waiver of Liability Statement Issued as Required by Payer Policy, Individual Case): Apply this modifier if an Advance Beneficiary Notice (ABN) was issued to the patient, indicating that the patient may be responsible for payment.
13. Modifier GX (Notice of Liability Issued, Voluntary Under Payer Policy): Use this modifier when a voluntary ABN was issued for a service that is not covered.
14. Modifier GY (Item or Service Statutorily Excluded, Does Not Meet the Definition of Any Medicare Benefit): Apply this modifier if the service is statutorily excluded from Medicare coverage.
15. Modifier GZ (Item or Service Expected to Be Denied as Not Reasonable and Necessary): Use this modifier if the provider expects that Medicare will deny the service as not reasonable and necessary, and no ABN was issued.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 17272 is reimbursed by Medicare, but the reimbursement rate can vary based on several factors. To determine if and how much Medicare will reimburse for CPT code 17272, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, reimbursement can be influenced by the specific Medicare Administrative Contractor (MAC) that processes claims in your region. Each MAC may have different local coverage determinations (LCDs) and policies that could affect the reimbursement for CPT code 17272. Therefore, it is essential to consult both the MPFS and your regional MAC for the most accurate and up-to-date information.
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