CPT code 15835 is for the excision of excessive skin from the buttocks, typically performed to improve contour and remove excess tissue.
CPT code 15835 is used to describe the surgical procedure for excising (removing) excessive skin from the buttocks. This code is typically utilized when a patient has an overabundance of skin in the buttock area, which may be due to significant weight loss, aging, or other medical conditions. The procedure aims to improve the contour and appearance of the buttocks by removing the excess skin.
When using CPT code 15835 for excising excessive skin from the buttock, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or unusual circumstances.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both buttocks during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session. This indicates that the excision of excessive skin was one of several procedures.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It helps to clarify that the excision was a separate and necessary procedure.
5. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the same procedure more than once on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician performed the same procedure on the same day.
7. 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 if the patient had to return to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure was unrelated to the original surgery and occurred during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
11. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- This modifier is used when an assistant surgeon is necessary because a qualified resident surgeon was not available.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 15835 is subject to reimbursement by Medicare, but its eligibility for payment is determined by several factors. The Medicare Physician Fee Schedule (MPFS) outlines the payment rates for services covered under Medicare Part B, including surgical procedures. However, the final decision on reimbursement for CPT code 15835 also depends on the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) for the region in which the service is provided.
Each MAC has the authority to interpret national Medicare policies and may have local coverage determinations (LCDs) that affect whether a particular service is reimbursed. Therefore, it is crucial for healthcare providers to consult both the MPFS and their respective MAC's guidelines to ascertain the reimbursement status of CPT code 15835.
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