CPT® Code 96933

Official Description

Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation and report only, first lesion

Common Language Description

Reflectance confocal microscopy (RCM) is a sophisticated, non-invasive imaging technique utilized for the detailed examination of skin lesions at the cellular and sub-cellular levels. This procedure is particularly valuable in the assessment of skin conditions, allowing healthcare professionals to investigate both benign and malignant tumors that may arise from melanocytes, which are pigment-producing cells, and keratinocytes, the predominant cell type in the outer layer of the skin. During the RCM process, a diode laser emits near-infrared light that is precisely focused on the targeted skin area. As this light penetrates the cellular structures, it interacts with them, resulting in variations in the refraction indexes and natural light reflections. These interactions are captured and processed using advanced computer software to generate a two-dimensional grayscale image that reveals intricate microscopic details of the skin lesion. The high-resolution images produced through this method can facilitate a histological analysis, providing critical insights into the nature of the lesion being examined. It is important to note that CPT® Code 96933 specifically pertains to the interpretation and reporting of findings from RCM for the first lesion, distinguishing it from other related codes that encompass image acquisition and additional lesions.

1. Indications

The procedure of reflectance confocal microscopy (RCM) is indicated for the evaluation of various skin lesions, particularly when there is a need to differentiate between benign and malignant conditions. The following conditions may warrant the use of RCM:

Skin Lesions Assessment of suspicious skin lesions that may require further investigation to determine their nature.
Melanocytic Tumors Evaluation of tumors arising from melanocytes, which may include melanoma or other pigmented lesions.
Keratinocytic Tumors Investigation of tumors originating from keratinocytes, which can include squamous cell carcinoma and basal cell carcinoma.

2. Procedure

The procedure for reflectance confocal microscopy (RCM) involves several key steps that ensure accurate imaging and analysis of skin lesions. The following outlines the procedural steps:

Step 1: Preparation The patient is positioned comfortably, and the area of the skin lesion is prepared for examination. This may involve cleaning the skin to remove any debris or oils that could interfere with imaging.
Step 2: Application of the RCM Device The RCM device is then applied to the skin lesion. The device utilizes a diode laser to emit near-infrared light, which is focused on the targeted area. The operator ensures that the device is properly aligned to capture the most relevant images of the lesion.
Step 3: Image Acquisition As the laser light penetrates the skin, it interacts with the cellular structures, producing various reflections and refractions. The RCM system captures these interactions in real-time, generating high-resolution images of the skin at different depths.
Step 4: Interpretation and Reporting After the images are acquired, the healthcare professional interprets the findings. This involves analyzing the microscopic details visible in the grayscale images to assess the characteristics of the lesion. A comprehensive report is then generated, summarizing the findings and providing insights into the nature of the lesion.

3. Post-Procedure

Post-procedure care for reflectance confocal microscopy is generally minimal, as the procedure is non-invasive and does not typically require any recovery time. Patients may resume their normal activities immediately following the examination. However, it is advisable for patients to monitor the site of the procedure for any unusual changes or reactions. The healthcare provider may schedule a follow-up appointment to discuss the results of the RCM interpretation and any further steps that may be necessary based on the findings.

Short Descr	RCM CELULR SUBCELULR IMG SKN
Medium Descr	RCM CELULR & SUBCELULR SKN IMGNG I&R 1ST LES
Long Descr	Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation and report only, first lesion
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	2 - Professional Component Only Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x)
Berenson-Eggers TOS (BETOS)	T1H - Lab tests - other (non-Medicare fee schedule)
MUE	1

This is a primary code that can be used with these additional add-on codes.

96936

Addon Code MPFS Status: Active Code APC N Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; interpretation and report only, each additional lesion (List separately in addition to code for primary procedure)

GC	This service has been performed in part by a resident under the direction of a teaching physician
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
Q1	Routine clinical service provided in a clinical research study that is in an approved clinical research study
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service