CPT code 15935 is a medical code used to document the removal of a pressure sore from the sacrum.
CPT code 15935 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 typically caused by prolonged pressure on the skin and underlying tissues. The procedure involves removing the damaged tissue to promote healing and prevent further complications.
When using CPT code 15935 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 anticipated (staged) or if it was more extensive than the original procedure.
5. Modifier 59 - Distinct Procedural Service
- Use 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
- Apply 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
- Use 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
- This modifier is used if the patient had to return to the operating room unexpectedly for a related procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the procedure was unrelated to the original surgery and occurred during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary 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
- This modifier is used when a non-physician provider assists in the surgery.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always verify the necessity and appropriateness of each modifier based on the specific details of the procedure performed.
The CPT code 15935, 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 detailed information on the payment rates for services covered under Medicare Part B.
Additionally, it is essential to consult with the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can provide guidance on whether CPT code 15935 is covered and the specific reimbursement rates applicable. Each MAC may have slightly different policies and interpretations, so verifying with your regional MAC ensures accurate and up-to-date information.
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