CPT code 15931 is used for the surgical removal of a pressure sore located on the sacrum.
CPT code 15931 is used to describe the surgical procedure for the removal of a pressure sore located on the sacrum. This code is specifically assigned to the medical service where a healthcare provider surgically excises the pressure ulcer, which is often necessary to prevent infection and promote healing in patients who have developed sores due to prolonged pressure on the sacral area.
When using CPT code 15931 for the removal of a sacrum pressure sore, 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
- 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 53 - Discontinued Procedure
- Used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 62 - Two Surgeons
- Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team
- Used when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician
- Used when the same procedure is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician
- Used when the same procedure is repeated by a different physician.
11. 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.
12. 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.
13. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
15. 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.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional information about the circumstances of the procedure and ensure accurate billing and reimbursement.
The CPT code 15931, which involves the removal of a sacrum pressure sore, is subject to reimbursement by Medicare. To determine if this specific CPT code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. Additionally, it is essential to consult with the local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement for CPT code 15931. Each MAC may have unique policies and guidelines, so verifying with the local MAC ensures accurate and up-to-date information.
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