CPT code 15116 is for an additional epidermal autograft on face, neck, hands, or feet.
CPT code 15116 is used to describe an additional procedure for an epidermal autograft, specifically for the face, neck, hands, feet, or genitalia. This code is applied when an additional area requires grafting beyond the initial site covered by the primary code. It ensures accurate billing and documentation for the extended scope of the grafting procedure.
For CPT code 15116, which pertains to epidermal autografts for face, neck, hands, feet, or genitalia, additional, the following modifiers may be applicable:
1. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Used when the procedure is planned or anticipated (staged) or more extensive than the original procedure.
2. Modifier 59 - Distinct Procedural Service
- Indicates that a procedure or service was distinct or independent from other services performed on the same day.
3. 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 provider.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when the same procedure is repeated by a different provider.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
- Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
7. Modifier LT - Left Side (used to identify procedures performed on the left side of the body)
- Indicates that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side (used to identify procedures performed on the right side of the body)
- Indicates that the procedure was performed on the right side of the body.
9. Modifier 22 - Increased Procedural Services
- Used when the work required to provide a service is substantially greater than typically required.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
- Indicates that an E/M service performed during the postoperative period was unrelated to the original procedure.
11. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
- Used when an E/M service is provided on the same day as a procedure but is distinct and separately identifiable from the procedure.
12. Modifier 50 - Bilateral Procedure
- Indicates that the procedure was performed on both sides of the body.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 15116 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect reimbursement for CPT code 15116. The MACs are responsible for processing Medicare claims and can provide the most accurate and up-to-date information regarding coverage and payment policies.
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