CPT code 15260 is a medical code used to describe a full-thickness skin graft procedure for the face, ears, eyelids, nose, or lips.
CPT code 15260 is used to describe a medical procedure involving a full-thickness skin graft to the face, ears, eyelids, nose, or lips. This code is specifically for grafts that cover a defect area of up to 20 square centimeters. Full-thickness skin grafts include both the epidermis and the entire dermis, providing a more durable and aesthetically pleasing result compared to partial-thickness grafts. This procedure is typically performed to repair skin loss due to trauma, surgery, or other medical conditions.
When using CPT code 15260, which pertains to a skin full graft for the face, ears, eyelids, nose, or lips, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unusual circumstances.
2. Modifier 50 - Bilateral Procedure: If the skin graft is performed on both sides of the body, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that more than one procedure was carried out.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the skin graft is part of a staged procedure or if it is related to the initial surgery and performed during the postoperative period.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: If the same procedure is repeated by the same provider, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by a different provider.
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: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be appended.
11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: This modifier is used when a non-physician provider assists in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 15260 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and pricing.
Additionally, reimbursement for CPT code 15260 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret national policies and make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to obtain precise information on the reimbursement status and any specific requirements or limitations associated with CPT code 15260.
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