CPT code 15769 is for the grafting of autologous soft tissue with a direct excision, used in various reconstructive procedures.
CPT code 15769 is used to describe a procedure where a graft of autologous soft tissue is directly excised. This means that a surgeon removes a piece of the patient's own soft tissue, such as fat or skin, and uses it to repair or reconstruct another area of the body. This code is specific to the direct excision method, indicating that the tissue is taken directly from the donor site without any intermediate steps.
Certainly! Here is a list of modifiers that could be used with CPT code 15769, along with the reasons for each:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure
- Indicates that the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same session.
4. Modifier 52 - Reduced Services
- Indicates that a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Indicates that a procedure or service was repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Indicates that a procedure or service was repeated by a different provider.
8. 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
- Used when a related procedure is performed during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
- Indicates that an unrelated procedure was performed during the postoperative period of the initial procedure.
10. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Indicates that a minimum assistant surgeon was required for the procedure.
12. 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.
13. 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 15769, which pertains to a specific medical procedure, is subject to reimbursement by Medicare under certain 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 payment rates for services covered by Medicare, including whether a particular CPT code is reimbursable.
Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage policies, including any local coverage determinations (LCDs) that may affect the reimbursement of CPT code 15769. By checking both the MPFS and consulting with your MAC, you can ascertain whether Medicare will reimburse for this specific procedure.
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