CPT code 41113 is for the excision of a lesion on the tongue, detailing the specific procedure for billing and documentation in healthcare.
CPT code 41113 is for the excision of a lesion on the tongue. This procedure involves the surgical removal of abnormal tissue from the tongue, which may be necessary for diagnostic purposes or to treat conditions such as tumors or other growths. The excision can vary in complexity depending on the size and location of the lesion, and it is typically performed by an oral surgeon or an ENT specialist.
For CPT code 41113 (Excision of tongue lesion), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the tongue.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another physician.
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.
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.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 41113 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates.
Additionally, the reimbursement for CPT code 41113 may vary depending on the local policies of the Medicare Administrative Contractor (MAC) that services your region. Each MAC has the authority to implement local coverage determinations (LCDs) that can affect whether and how a particular CPT code is reimbursed.
Therefore, it is essential to consult both the MPFS and your regional MAC's guidelines to ensure proper reimbursement for CPT code 41113.
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