CPT code 15278 is used for skin substitute grafts on the face, neck, hands, or feet, including additional areas.
CPT code 15278 is used for reporting the application of a skin substitute graft to the face, neck, hands, feet, or genitalia. This code specifically covers additional areas treated beyond the primary site. It is typically used in cases where skin grafts are necessary due to burns, wounds, or other conditions requiring skin replacement in these sensitive and complex anatomical regions.
For CPT code 15278, 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 a subsequent procedure is planned or anticipated and is related to the initial 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 an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
7. Modifier LT - Left Side (Used to identify procedures performed on the left side of the body)
- Specifies 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)
- Specifies that the procedure was performed on the right side of the body.
9. Modifier 22 - Increased Procedural Services
- Indicates that the work required to provide the service was substantially greater than typically required.
10. Modifier 50 - Bilateral Procedure
- Used when the same procedure is performed on both sides of the body during the same operative session.
11. Modifier 51 - Multiple Procedures
- Indicates that multiple procedures were performed at the same session.
12. Modifier 52 - Reduced Services
- Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
13. Modifier 53 - Discontinued Procedure
- Indicates that a procedure was started but discontinued.
14. Modifier 62 - Two Surgeons
- Used when two surgeons work together as primary surgeons performing distinct parts of a procedure.
15. Modifier 66 - Surgical Team
- Indicates that a surgical team was required to perform the procedure.
16. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
17. Modifier 81 - Minimum Assistant Surgeon
- Indicates that a minimum assistant surgeon was required.
18. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required and a qualified resident surgeon is not available.
19. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery
- Indicates that a non-physician provider assisted in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 15278 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 15278. Each MAC may have unique policies or requirements that could influence the reimbursement process.
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