CPT code 17313 is for Mohs micrographic surgery, involving the removal of a skin cancer in one stage on the trunk, arms, or legs.
CPT code 17313 is used to describe the first stage of Mohs micrographic surgery for the removal of a tumor on the trunk, arms, or legs. This code specifically covers the initial stage of the procedure, where the surgeon removes the visible portion of the tumor along with a thin layer of surrounding tissue. The tissue is then examined under a microscope to check for cancer cells, ensuring that all cancerous tissue is removed while sparing as much healthy tissue as possible.
For CPT code 17313, which pertains to Mohs micrographic surgery, the following modifiers may be applicable:
1. 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.
2. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
3. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
4. 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 requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
5. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
6. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a staged or related procedure or service by the same physician during the postoperative period of the initial procedure is planned or anticipated.
7. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for the additional work.
8. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures, other than E/M services, are performed at the same session by the same provider. This is to indicate that the procedures are distinct and separate.
9. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): This modifier is used when a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
10. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): This modifier is used when an unrelated E/M service is provided by the same physician during the postoperative period of a procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 17313 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To determine the exact reimbursement for CPT code 17313, healthcare providers should consult the MPFS, which is updated annually to reflect changes in policy and reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and providing guidance on Medicare coverage. Each MAC may have specific local coverage determinations (LCDs) that can affect the reimbursement of CPT code 17313. Therefore, it is essential for providers to verify the details with their respective MAC to ensure compliance and accurate reimbursement.
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 17313. Schedule a demo today to see how RevFind can help you identify and recover every dollar you're owed from each payer.
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