CPT code 17304 is for a 1-stage Mohs surgery procedure involving up to 5 tissue specimens.
CPT code 17304 is used to describe a procedure known as Mohs micrographic surgery, specifically for the first stage of the surgery where up to five tissue specimens are examined. This code is utilized by healthcare providers to bill for the meticulous process of removing skin cancer layer by layer, examining each layer under a microscope until no cancer cells remain. This precise method ensures that all cancerous tissue is removed while sparing as much healthy tissue as possible.
When using CPT code 17304, which pertains to a specific medical procedure, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 (Bilateral Procedure): Apply this modifier if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 (Multiple Procedures): Use this modifier when multiple procedures are performed during the same session. This helps indicate that the procedure is one of several performed.
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. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
5. Modifier 76 (Repeat Procedure by Same Physician): Use this modifier if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 (Repeat Procedure by Another Physician): Apply this modifier if the same procedure is repeated by a different physician 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 used when a patient returns to the operating room for a related procedure during the postoperative period of the initial procedure.
8. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service provided accurately.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 17304 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT 17304 is covered and the reimbursement rate, 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, it is essential to consult the local Medicare Administrative Contractor (MAC) for region-specific guidelines and policies. MACs are responsible for processing Medicare claims and can provide insights into any local coverage determinations (LCDs) that might affect the reimbursement of CPT 17304. By checking both the MPFS and the relevant MAC, providers can ensure they have the most accurate and up-to-date information regarding the reimbursement of this CPT code.
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