CPT CODES

CPT Code 15786

CPT code 15786 is used for the medical procedure involving the abrasion of a single lesion.

Table of Contents
What is CPT Code 15786
Does CPT 15786 Need a Modifier?
CPT Code 15786 Medicare Reimbursement
Are You Being Underpaid for 15786 CPT Code?
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What is CPT Code 15786

CPT code 15786 is used to describe the medical procedure of abrading a single lesion. This involves the controlled removal of the outer layers of skin from a specific lesion, typically to treat or diagnose skin conditions. The procedure is often performed using specialized tools to carefully scrape away the affected area, promoting healing or preparing the site for further treatment.

Does CPT 15786 Need a Modifier?

For CPT code 15786 (Abrasion lesion single), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required.

2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be appended.

3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same session, this modifier should be used.

4. Modifier 52 - Reduced Services: If the procedure is partially reduced or eliminated at the physician's discretion, this modifier should be applied.

5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.

6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier should be used.

7. Modifier 77 - Repeat Procedure by Another Physician: If the same procedure is repeated by a different physician, this modifier should be appended.

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: Use this modifier if the patient returns 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: This modifier should be used if an unrelated procedure is performed by the same physician during the postoperative period.

10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be appended.

11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required.

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.

13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when these non-physician practitioners assist in the surgery.

14. Modifier LT - Left Side: If the procedure is performed on the left side of the body, this modifier should be used.

15. Modifier RT - Right Side: If the procedure is performed on the right side of the body, this modifier should be appended.

These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.

CPT Code 15786 Medicare Reimbursement

The CPT code 15786 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS).

The MPFS provides detailed information on the payment rates and guidelines for services covered under Medicare. Additionally, the reimbursement for CPT code 15786 may vary depending on the local policies set by the Medicare Administrative Contractor (MAC) for your region.

It is essential to consult the MPFS and your regional MAC to determine the exact reimbursement details and any additional requirements that may apply.

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