CPT code 21555 is for the excision of a neck lesion smaller than 3 cm.
CPT code 21555 is used for the surgical procedure involving the excision (removal) of a lesion (abnormal tissue) from the neck area, where the lesion is smaller than 3 centimeters. This code helps healthcare providers and insurance companies understand the specific type of surgery performed.
When billing for CPT code 21555 (Excision of tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Used when 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
- Used if the procedure is performed on both sides of the body during the same operative session.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 52 - Reduced Services
- Used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. 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. This modifier is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when the same procedure is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when the same procedure is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure.
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
- Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side
- Used to specify that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- Used to specify that the procedure was performed on the right side of the body.
12. Modifier XS - Separate Structure
- Used to indicate that a service was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter
- Used to indicate that a service was performed during a separate encounter.
14. Modifier XP - Separate Practitioner
- Used to indicate that a service was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service
- Used to indicate that the use of a service does not overlap usual components of the main service.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate billing and reimbursement for the services provided.
When determining if a specific CPT code, such as 21555 (Excision of neck lesion, subcutaneous, less than 3 cm), 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).
For CPT code 21555, Medicare does provide reimbursement, but the exact amount can vary based on geographic location and other factors. As of the latest available data, the national average reimbursement rate for CPT code 21555 is approximately $300. However, this amount can differ based on the specific locality adjustments and any additional considerations such as facility vs. non-facility settings.
To obtain the most accurate and up-to-date reimbursement information, healthcare providers should refer to the MPFS Look-Up Tool on the Centers for Medicare & Medicaid Services (CMS) website or consult their local MAC. This ensures that providers have the latest data and can account for any regional variations in reimbursement rates.
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. For instance, if you're billing for CPT code 21555, RevFind ensures you're receiving the correct reimbursement for excising neck lesions smaller than 3 cm. Schedule a demo today to see how RevFind can optimize your revenue cycle and safeguard your practice's financial health.
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