CPT code 15920 is for the surgical removal of an ulcer located on the tailbone.
CPT code 15920 is used for the surgical procedure involving the removal of an ulcer located on the tailbone (coccyx). This code is specifically designated for the excision of pressure ulcers that have developed in the sacrococcygeal area, often due to prolonged pressure or immobility. The procedure typically involves the removal of the ulcerated tissue to promote healing and prevent further complications.
For CPT code 15920, which pertains to the removal of a tail bone ulcer, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used 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: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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 when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during 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: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.
When determining if CPT code 15920 is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC, which administers Medicare claims for a specific jurisdiction, may have additional guidelines or requirements for reimbursement.
For CPT code 15920, you would need to verify its status on the MPFS to see if it is listed and whether it has an assigned reimbursement rate. Additionally, checking with your regional MAC can provide further clarification on any local coverage determinations (LCDs) or specific billing requirements that may affect reimbursement. Generally, if the code is listed on the MPFS with an assigned value and there are no restrictive LCDs from the MAC, it is likely to be reimbursed by Medicare.
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