CPT code 15361 is for applying a cultured dermal substitute to the trunk, arms, or legs as an additional procedure.
CPT code 15361 is used for the application of a cultured dermal substitute to areas such as the trunk, arms, or legs. This code specifically refers to the additional application of the dermal substitute beyond the initial area treated. It is typically used in procedures where skin grafts or substitutes are necessary to promote healing in patients with severe wounds, burns, or other skin conditions.
For CPT code 15361, which pertains to the application of a cultured dermal substitute, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could apply if the application of the cultured dermal substitute is more complex than usual.
2. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both sides of the body. This would be relevant if the cultured dermal substitute is applied to symmetrical areas on both sides.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same session. This could apply if the application of the cultured dermal substitute is one of several procedures performed.
4. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Used if the application of the cultured dermal substitute is planned as a staged procedure or is related to the initial procedure.
5. Modifier 59 (Distinct Procedural Service): Used to indicate that the procedure is distinct or independent from other services performed on the same day. This could apply if the application of the cultured dermal substitute is performed in a different anatomical site or for a different reason than other procedures.
6. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Used if the same procedure is repeated by the same provider. This could apply if the cultured dermal substitute needs to be reapplied.
7. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Used if the same procedure is repeated by a different provider. This could apply if the cultured dermal substitute needs to be reapplied by another healthcare professional.
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): 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): Used if the application of the cultured dermal substitute is unrelated to the original procedure and occurs during the postoperative period.
10. Modifier 80 (Assistant Surgeon): Used if an assistant surgeon is required for the procedure.
11. Modifier 81 (Minimum Assistant Surgeon): Used if a minimum assistant surgeon is required for the procedure.
12. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used if an assistant surgeon is required and a qualified resident surgeon is not available.
13. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used if a non-physician provider assists 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 15361, which involves a specific medical procedure, is reimbursed by Medicare. To determine the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for various services covered by Medicare. Additionally, it is essential to consult with your regional Medicare Administrative Contractor (MAC) for any specific guidelines or variations in reimbursement policies that may apply to your locality. The MACs are responsible for processing Medicare claims and can provide further clarification on coverage and reimbursement for CPT code 15361.
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