CPT code 15273 is used for skin substitute grafts applied to the arm or leg of a child, covering the procedure and materials used.
CPT code 15273 is used to describe the procedure of applying a skin substitute graft to the trunk, arms, or legs of a child. This code specifically refers to the process where a skin graft is placed on a wound or damaged area to promote healing and restore the skin's integrity. The procedure involves preparing the recipient site, selecting an appropriate skin substitute, and carefully applying it to ensure optimal results. This code is essential for accurate billing and documentation in pediatric dermatological and surgical care.
For CPT code 15273, 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 health care 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 substitute graft.
2. Modifier 50: Bilateral procedure. Use this modifier if the skin substitute graft was performed on both arms or legs.
3. Modifier 51: Multiple procedures. Use this modifier if multiple procedures were performed during the same session.
4. Modifier 59: Distinct procedural service. Use this modifier to indicate that the skin substitute graft was a distinct service from other procedures performed on the same day.
5. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the skin substitute graft was repeated on the same day.
6. Modifier 77: Repeat procedure by another physician or other qualified health care professional. Use this modifier if the skin substitute graft was repeated on the same day by a different provider.
7. 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. Use this modifier if the patient required an additional skin substitute graft procedure during the postoperative period.
8. Modifier 79: Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period. Use this modifier if the skin substitute graft was unrelated to the initial procedure performed during the postoperative period.
9. Modifier 80: Assistant surgeon. Use this modifier if an assistant surgeon was required for the skin substitute graft procedure.
10. Modifier 81: Minimum assistant surgeon. Use this modifier if a minimum assistant surgeon was required for the skin substitute graft procedure.
11. Modifier 82: Assistant surgeon (when qualified resident surgeon not available). Use this modifier if an assistant surgeon was required due to the unavailability of a qualified resident surgeon.
12. Modifier AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery. Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the skin substitute graft procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 15273, which involves a specific medical procedure, is subject to reimbursement by Medicare. 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 for various CPT codes, including 15273. Additionally, it is essential to consult with the local Medicare Administrative Contractor (MAC) as they administer Medicare claims and can provide specific guidance on coverage and reimbursement policies for this CPT code. Each MAC may have unique guidelines and requirements, so verifying with the appropriate MAC is crucial for accurate reimbursement information.
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