CPT Code 26111

CPT code 26110 is a medical code used to describe the procedure of performing a biopsy on the lining of a finger joint.

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What is CPT Code 26111

CPT code 26111 is used to describe a surgical procedure involving the excision of a lesion from the hand, specifically one that is 1.5 centimeters or smaller in size. This code is utilized by healthcare providers to document and bill for the removal of such lesions, ensuring accurate and standardized reporting for insurance and reimbursement purposes.

Does CPT 26111 Need a Modifier?

For CPT code 26111 (Excision of lesion of the hand or finger, subcutaneous tissue; less than 1.5 cm), 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 hands or fingers during the same session.

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 LT - Left Side: Used to indicate that the procedure was performed on the left hand or finger.

11. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right hand or finger.

12. Modifier XS - Separate Structure: Used to indicate a service that is distinct because it was performed on a separate organ/structure.

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

CPT Code 26111 Medicare Reimbursement

The CPT code 26111 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes. Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) that services your region. Each MAC may have specific coverage determinations and guidelines that could affect the reimbursement of CPT code 26111. Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information.

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