CPT Code 22902

CPT code 22902 is for the excision of an abdominal lesion smaller than 3 cm.

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What is CPT Code 22902

CPT code 22902 is used to describe the excision of an abdominal lesion that is smaller than 3 centimeters. This code is specifically for procedures where the lesion is surgically removed from the abdominal area, and the size of the lesion is less than 3 cm in diameter. This code helps in standardizing the billing process for such procedures, ensuring that healthcare providers can accurately document and charge for the service provided.

Does CPT 22902 Need a Modifier?

For CPT code 22902 (Excision, abdominal wall lesion, subcutaneous, less than 3 cm), the following modifiers may be applicable:

1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or difficulty.

2. Modifier 50 (Bilateral Procedure): Applied 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 59 (Distinct Procedural Service): Indicates that the procedure is distinct or independent from other services performed on the same day. This is used to avoid bundling issues and to show that the procedures are separate and not part of a more comprehensive service.

5. Modifier LT (Left Side): Used to specify that the procedure was performed on the left side of the body.

6. Modifier RT (Right Side): Used to specify that the procedure was performed on the right side of the body.

7. Modifier 76 (Repeat Procedure by Same Physician): Applied when the same procedure is repeated by the same physician on the same day.

8. Modifier 77 (Repeat Procedure by Another Physician): Used when the same procedure is repeated by a different physician on the same day.

9. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Indicates that the patient required a return to the operating room for a related procedure during the postoperative period.

10. 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.

11. Modifier 80 (Assistant Surgeon): Indicates that an assistant surgeon was required for the procedure.

12. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required for the procedure.

13. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available.

14. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used when a non-physician practitioner assists in the surgery.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.

CPT Code 22902 Medicare Reimbursement

The CPT code 22902 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT code 22902 is covered and the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 22902.

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