CPT code 17312 is used for billing additional stages of Mohs micrographic surgery, a precise technique for removing skin cancer.
CPT code 17312 is used to describe an additional stage of Mohs micrographic surgery. This code is specifically applied when a surgeon needs to perform an extra layer of tissue removal and examination beyond the initial stage. Mohs surgery is a precise technique used to treat skin cancer, where layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. The use of CPT code 17312 indicates that the procedure required more than one stage to ensure all cancerous cells were eradicated.
For CPT code 17312, which pertains to Mohs micrographic surgery for additional stages, the following modifiers may be applicable:
1. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Used when a subsequent procedure is planned or anticipated and is related to the initial procedure.
2. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Applied when the same procedure is repeated by the same provider.
3. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when the same procedure is repeated by a different provider.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- Utilized when an unplanned return to the operating room is necessary for a related procedure.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Applied when an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
6. Modifier 59 - Distinct Procedural Service
- Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier XS - Separate Structure
- Indicates that a service was performed on a separate organ/structure.
8. Modifier XE - Separate Encounter
- Used to denote that a service was performed during a separate encounter.
9. Modifier XP - Separate Practitioner
- Indicates that a service was performed by a different practitioner.
10. Modifier XU - Unusual Non-Overlapping Service
- Used to indicate that a service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether CPT code 17312 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates.
To verify if CPT code 17312 is reimbursed, you would need to:
1. Check the MPFS: Access the MPFS database to see if CPT code 17312 is listed and review the reimbursement rate for the service. The MPFS is updated annually, so ensure you are referencing the most current version.
2. Consult Your MAC: Each MAC may have specific guidelines or local coverage determinations (LCDs) that affect reimbursement. It's essential to review the policies of your regional MAC to confirm if there are any additional requirements or restrictions for CPT code 17312.
By following these steps, you can determine if CPT code 17312 is reimbursed by Medicare and understand any specific conditions that may apply.
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. Ensure you're receiving accurate reimbursements for every service, including specific codes like 17312. Schedule a demo today to see how RevFind can optimize your revenue cycle management and safeguard your practice's financial health.
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
