CPT code 15272 is for an additional skin substitute graft applied to a wound, typically used in complex wound care procedures.
CPT code 15272 is used to describe the application of a skin substitute graft to a wound on the trunk, arms, or legs. This code specifically refers to an additional area of 25 square centimeters or less, beyond the initial area covered by the primary procedure code. It is an add-on code, meaning it is used in conjunction with another primary procedure code to indicate that an extra area has been treated. This code helps ensure accurate billing and reimbursement for the additional work performed by healthcare providers.
For CPT code 15272, which pertains to skin substitute grafts, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the skin graft procedure.
2. Modifier 50: Bilateral procedure. Use this modifier if the skin graft procedure was performed on both sides of the body.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same surgical session.
4. Modifier 58: Staged or related procedure or service by the same physician or other qualified healthcare professional during the postoperative period. Use this modifier if the skin graft is part of a planned series of procedures.
5. Modifier 59: Distinct procedural service. Use this modifier to indicate that the skin graft procedure was distinct or independent from other services performed on the same day.
6. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. Use this modifier if the skin graft procedure needed to be repeated.
7. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. Use this modifier if the skin graft procedure was repeated by a different provider.
8. Modifier 78: Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period. Use this modifier if the patient had to return to the operating room for a related procedure.
9. Modifier 79: Unrelated procedure or service by the same physician or other qualified healthcare professional during the postoperative period. Use this modifier if the skin graft procedure was unrelated to the original procedure performed.
10. Modifier 91: Repeat clinical diagnostic laboratory test. Use this modifier if the skin graft procedure required repeat laboratory tests.
11. Modifier LT: Left side. Use this modifier if the skin graft procedure was performed on the left side of the body.
12. Modifier RT: Right side. Use this modifier if the skin graft procedure was performed on the right side of the body.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
The CPT code 15272, which is an add-on code, is reimbursed by Medicare under specific conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including add-on codes like 15272.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement policies. Each MAC may have slightly different guidelines and requirements, so verifying with them ensures compliance and accurate reimbursement for services rendered.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 15272, and by individual payer. Schedule a demo today to see how RevFind can help you identify and recover lost revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
