CPT code 17999 is used for procedures on the skin, mucous membranes, or subcutaneous tissue that are not listed elsewhere.
CPT code 17999 is used for procedures that are performed on the skin, mucous membranes, or subcutaneous tissue but do not have a specific code assigned to them. This is a catch-all code for unlisted procedures in these areas, meaning it is used when no other CPT code accurately describes the procedure performed.
When using CPT code 17999, which is designated for unlisted procedures involving the skin, mucous membrane, or subcutaneous tissue, it is often necessary to include modifiers to provide additional information about the service performed. Below is a list of potential modifiers that could be used with CPT code 17999, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
- Use this modifier if a significant, separately identifiable E/M service is performed by the same physician on the same day as the procedure.
3. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure is performed on both sides of the body.
4. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same session.
5. Modifier 52 - Reduced Services
- Use this modifier if the procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
7. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure is repeated by the same physician.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure is repeated by a different physician.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient returns to the operating room for a related procedure during the postoperative period.
11. 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.
12. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
15. Modifier 99 - Multiple Modifiers
- Use this modifier if multiple modifiers are needed to describe the service.
Each of these modifiers provides specific information that can affect the billing and reimbursement process, ensuring that the claim accurately reflects the services provided.
Determining whether CPT code 17999 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). CPT code 17999, which is an unlisted procedure code, does not have a predetermined reimbursement rate on the MPFS. Therefore, reimbursement for this code is not guaranteed and is subject to the discretion of the MAC.
When submitting claims for CPT code 17999, it is essential to provide detailed documentation and justification for the procedure performed. The MAC will review the submitted information to determine if the service is medically necessary and if it qualifies for reimbursement. Additionally, the reimbursement amount, if approved, may vary based on the specifics of the case and the MAC's policies.
In summary, while CPT code 17999 is not explicitly listed on the MPFS, it may still be reimbursed by Medicare depending on the MAC's evaluation of the submitted documentation and medical necessity.
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