CPT code 15934 is for the surgical removal of a pressure sore located on the sacrum, typically performed to prevent infection and promote healing.
CPT code 15934 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 debridement or excision of the pressure ulcer, which involves removing dead or infected tissue to promote healing and prevent further complications. This procedure is typically necessary for patients who have developed pressure sores due to prolonged immobility or other underlying health conditions.
When using CPT code 15934 for the removal of a sacrum pressure sore, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used 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 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. 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 anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
4. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
5. 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.
6. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
7. Modifier LT (Left Side): This modifier is used to indicate that the procedure was performed on the left side of the body.
8. Modifier RT (Right Side): This modifier is used to indicate that the procedure was performed on the right side of the body.
9. Modifier 76 (Repeat Procedure or Service by Same Physician): This modifier is used when a procedure or service performed by the same physician is repeated subsequent to the original procedure or service.
10. Modifier 77 (Repeat Procedure by Another Physician): This modifier is used when a procedure or service performed by another physician is repeated subsequent to the original procedure or service.
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 15934 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, the MACs, which are regional entities contracted by Medicare, may have specific guidelines and coverage determinations that can affect reimbursement.
Therefore, it is crucial to consult both the MPFS and your MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 15934.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 15934. Schedule a demo today to see how RevFind can help you identify and recover every dollar you're owed from each payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
