CPT code 17276 is a medical code used for the procedure involving the destruction of skin lesions.
CPT code 17276 is used to describe the medical procedure for the destruction of skin lesions. This code specifically refers to the treatment where a healthcare provider removes abnormal skin growths, such as warts, moles, or other lesions, using methods like laser surgery, cryotherapy (freezing), or electrosurgery (burning). This procedure is typically performed to eliminate potentially harmful or bothersome skin lesions and to prevent them from causing further health issues.
When billing for the destruction of skin lesions using CPT code 17276, it is important to consider the appropriate modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 17276, along with the reasons for their use:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional 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.
- Use 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 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 procedural service from other services provided on the same day.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional.
- Use 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 healthcare 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 or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period.
- Use this modifier if the patient had to return to the procedure room for additional destruction of skin lesions related to the initial procedure.
8. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period.
- Use this modifier if the destruction of skin lesions was unrelated to the initial procedure and occurred during the postoperative period of another procedure.
9. Modifier LT: Left side (used to identify procedures performed on the left side of the body).
- Use this modifier if the destruction of skin lesions was performed on the left side of the body.
10. Modifier RT: Right side (used to identify procedures performed on the right side of the body).
- Use this modifier if the destruction of skin lesions was performed on the right side of the body.
11. Modifier GA: Waiver of liability statement issued as required by payer policy, individual case.
- Use this modifier if an Advance Beneficiary Notice (ABN) was issued to the patient, indicating that the patient may be responsible for payment if the payer denies the claim.
12. Modifier GX: Notice of liability issued, voluntary under payer policy.
- Use this modifier if a voluntary ABN was issued to the patient, even though it is not required by the payer.
13. Modifier GY: Item or service statutorily excluded or does not meet the definition of any Medicare benefit.
- Use this modifier if the destruction of skin lesions is not covered by Medicare or does not meet the definition of a Medicare benefit.
14. Modifier GZ: Item or service expected to be denied as not reasonable and necessary.
- Use this modifier if the provider expects that the destruction of skin lesions will be denied by Medicare as not reasonable and necessary, and no ABN was issued.
By using the appropriate modifiers, healthcare providers can ensure that their claims for CPT code 17276 are accurately processed and reimbursed.
The CPT code 17276 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 practice costs.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the specific reimbursement rates and any additional requirements for CPT code 17276.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 17276. Ensure you're receiving the full reimbursement you deserve from each payer. 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
