CPT code 15787 is used for billing the additional procedure of abrading lesions, often performed to treat skin conditions or prepare for further treatment.
CPT code 15787 is used to describe an additional procedure for the abrasion of lesions. This code is typically used when a healthcare provider performs an abrasion on multiple lesions during the same session. The "add-on" designation means that this code is not used alone but in conjunction with a primary procedure code. It helps ensure accurate billing and reimbursement for the extra work involved in treating additional lesions.
For CPT code 15787, which pertains to abrasion lesions as an add-on procedure, the following modifiers may be applicable:
1. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
2. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is used to avoid bundling issues and to show that the procedures are separate and necessary.
3. Modifier 76 (Repeat Procedure by Same Physician): This modifier is used when the same procedure is repeated by the same physician on the same day. It indicates that the procedure was necessary to be performed again.
4. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when the same procedure is repeated by a different physician on the same day. It indicates that the procedure was necessary to be performed again by another provider.
5. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): This modifier is used when the patient needs to return to the operating room for a related procedure during the postoperative period.
6. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required for the procedure. It indicates that another surgeon assisted in the procedure.
8. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required for the procedure. It indicates that the assistance was minimal but necessary.
9. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
10. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist 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 15787, which is an add-on code, is reimbursed by Medicare under specific 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 reimbursement rates and guidelines for various CPT codes, including add-on codes like 15787.
Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 15787 is covered in your region and under what circumstances. They can also offer insights into any documentation requirements or billing nuances that may affect reimbursement.
In summary, while CPT code 15787 can be reimbursed by Medicare, it is crucial to verify the specifics through the MPFS and your local MAC to ensure compliance and proper reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're getting paid what you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 15787, RevFind provides unparalleled accuracy by individual payer. Schedule a demo today to see how RevFind can optimize your revenue cycle and protect your bottom line.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
