CPT code 15130 is for a dermal autograft procedure on the trunk, arm, or leg, used for billing and documentation in healthcare services.
CPT code 15130 is used to describe a procedure where a dermatologist or surgeon takes a piece of skin from one part of a patient's body (known as an autograft) and transplants it to another area on the trunk, arm, or leg. This code specifically applies to the initial 100 square centimeters or 1% of body area of infants and children. This procedure is often necessary for treating extensive wounds, burns, or areas where skin has been lost due to surgery or injury.
For CPT code 15130, which pertains to dermal autografts on the trunk, arms, or legs, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Apply this modifier if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the procedure was planned or anticipated at the time of the original procedure.
6. Modifier 59 - Distinct Procedural Service: Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the procedure needs to be repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Apply this modifier if the procedure is repeated by a different physician.
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: Use this modifier for an unplanned return to the operating room for a related procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Apply this modifier if the procedure is unrelated to the original procedure performed during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Use this modifier when an assistant surgeon is required for the procedure.
12. Modifier 81 - Minimum Assistant Surgeon: Apply this modifier if a minimum assistant surgeon is required.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier when a qualified resident surgeon is not available, and an assistant surgeon is necessary.
14. Modifier 99 - Multiple Modifiers: Apply this modifier when multiple modifiers are necessary to describe the service performed.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement. Always refer to the latest CPT coding guidelines and payer-specific requirements for the most accurate and up-to-date information.
The CPT code 15130 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the allowable payment amounts for services covered under Medicare Part B.
Additionally, the reimbursement for CPT code 15130 may vary depending on the policies of the Medicare Administrative Contractor (MAC) that oversees the specific geographic region where the service is provided. Each MAC has the authority to implement local coverage determinations (LCDs) that can affect the reimbursement criteria for this CPT code.
Therefore, it is essential for healthcare providers to consult both the MPFS and their respective MAC's guidelines to ensure proper billing and reimbursement for CPT code 15130.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 15130. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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