CPT code 15922 is for the surgical removal of an ulcer located on the tailbone, ensuring proper wound care and healing.
CPT code 15922 is used for the surgical procedure involving the removal of an ulcer located on the tailbone (coccyx). This code is specifically designated for cases where a pressure ulcer, often caused by prolonged sitting or lying down, has developed on the tailbone and requires surgical intervention to remove the damaged tissue.
For CPT code 15922, "Removal of tail bone ulcer," the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure
- If the procedure is performed on both sides of the body, this modifier should be appended to indicate that the service was performed bilaterally.
3. Modifier 51 - Multiple Procedures
- When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that multiple services were provided.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances. It indicates that the procedures are distinct and separate from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician
- If the same procedure is repeated by the same physician, this modifier should be used to indicate that the procedure was repeated.
6. Modifier 77 - Repeat Procedure by Another Physician
- When the same procedure is repeated by a different physician, this modifier should be used to indicate that the procedure was repeated by another provider.
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 when a patient requires a return to the operating room for a related procedure during the postoperative period of the initial surgery.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to perform the procedure.
10. Modifier 81 - Minimum Assistant Surgeon
- When a minimum assistant surgeon is required, this modifier should be used.
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 is not available.
12. 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.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
The CPT code 15922 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have different local coverage determinations (LCDs) and payment policies. Therefore, it is advisable to consult the MPFS and the relevant MAC for precise information regarding the reimbursement of CPT code 15922.
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