CPT code 15933 is used for the surgical removal of a pressure sore located on the sacrum.
CPT code 15933 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 these sores due to prolonged pressure on the sacral area.
When using CPT code 15933 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
- Use this modifier if the procedure required significantly greater effort than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both sides of the body.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if the procedure was planned or staged at the time of the original procedure.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure was repeated by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the procedure was repeated by a different provider.
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
- Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure was performed by the same provider during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required for the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier if a PA, NP, or CNS assisted in the surgery.
14. Modifier LT - Left Side (used to identify procedures performed on the left side of the body)
- Use this modifier if the procedure was performed on the left side of the body.
15. Modifier RT - Right Side (used to identify procedures performed on the right side of the body)
- Apply this modifier if the procedure was performed on the right side of the body.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement. Always verify the specific payer requirements and guidelines when applying modifiers.
The CPT code 15933 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs are responsible for processing Medicare claims and can offer more localized information regarding coverage and reimbursement policies.
Therefore, it is advisable to consult both the MPFS and your MAC to ensure accurate and up-to-date information on the reimbursement status of CPT code 15933.
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