CPT code 21552 is for the excision of a neck lesion measuring 3 cm or less.
CPT code 21552 is for the surgical excision of a lesion from the neck that is larger than 3 centimeters. This code is used to document and bill for the procedure where a healthcare provider removes a sizable abnormal growth or tissue from the neck area.
For CPT code 21552, which pertains to the excision of a neck lesion measuring 3 cm or less, 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): If the procedure is performed on both sides of the neck, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that multiple services were provided.
4. Modifier 52 (Reduced Services): If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service provided was less than usually required.
5. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly important if the procedures are not typically reported together but are appropriate under the circumstances.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure is repeated by the same physician on the same day, this modifier should be used.
7. Modifier 77 (Repeat Procedure by Another Physician): If the same procedure is repeated by a different physician on the same day, this modifier should be used.
8. 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 if the patient requires a return to the operating room for a related procedure during the postoperative period.
9. 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.
10. Modifier 80 (Assistant Surgeon): If an assistant surgeon is required for the procedure, this modifier should be appended.
11. Modifier 81 (Minimum Assistant Surgeon): Use this modifier if a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Use this modifier when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
When determining if a specific CPT code, such as 21552 (Excision of tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater), is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and Local Coverage Determinations (LCDs) provided by Medicare Administrative Contractors (MACs).
As of the latest update, CPT code 21552 is generally reimbursed by Medicare, provided that the procedure is deemed medically necessary and meets the documentation requirements. The reimbursement amount can vary based on geographic location and other factors. For instance, the national average reimbursement rate for CPT code 21552 is approximately $500, but this amount can fluctuate.
To obtain the most accurate and current reimbursement rate for CPT code 21552, healthcare providers should refer to the MPFS and check with their specific MAC. Additionally, it is advisable to verify any specific coverage policies or pre-authorization requirements that may apply to ensure compliance and optimize reimbursement.
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