CPT code 15936 is for the surgical removal of a pressure sore located on the sacrum.
CPT code 15936 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 intervention where a healthcare provider surgically excises a pressure ulcer, which is a type of chronic wound that typically develops due to prolonged pressure on the skin and underlying tissues. The sacrum is the triangular bone at the base of the spine, and pressure sores in this area can be particularly challenging to treat due to their location and the potential for complications. This CPT code ensures that the procedure is accurately documented for billing and insurance purposes.
For CPT code 15936, which pertains to the removal of a sacrum pressure sore, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as the size or complexity of the pressure sore.
2. Modifier 51 - Multiple Procedures: Apply this modifier if multiple procedures were performed during the same surgical session. This is common in cases where additional pressure sores or related issues are addressed concurrently.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the removal of the sacrum pressure sore is part of a staged or planned series of procedures.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It helps to clarify that the removal of the sacrum pressure sore was a separate and necessary procedure.
5. Modifier 76 - Repeat Procedure or Service by Same Physician: Apply this modifier if the procedure needs to be repeated by the same physician due to recurrence or other clinical reasons.
6. 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 needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
8. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left side of the body.
9. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right side of the body.
10. Modifier QX - CRNA Service: With Medical Direction by a Physician: Apply this modifier if a Certified Registered Nurse Anesthetist (CRNA) is involved in the procedure under the medical direction of a physician.
11. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist: Use this modifier if an anesthesiologist is providing medical direction to one CRNA during the procedure.
12. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: This modifier is used if an anesthesiologist is directing multiple anesthesia procedures concurrently.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate reimbursement and compliance with payer requirements.
The CPT code 15936, which involves the removal of a sacrum pressure sore, is reimbursed by Medicare, but the specifics of reimbursement can vary. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including their respective reimbursement rates. However, the final determination of reimbursement for CPT code 15936 is often made by the Medicare Administrative Contractor (MAC) responsible for your geographic region. Each MAC may have different guidelines and policies that influence whether and how much Medicare will reimburse for this particular procedure. Therefore, it is essential to consult the MPFS and your local MAC to get precise information on the reimbursement for CPT code 15936.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can read your contracts and detect underpayments down to the CPT code level, including specific codes like 15936. Don't let underpayments slip through the cracks—schedule a demo today and see how RevFind can optimize your revenue cycle management.
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
