CPT code 15937 is for the surgical removal of a pressure sore located on the sacrum, typically performed to prevent infection and promote healing.
CPT code 15937 is used to describe the surgical procedure for the removal of a pressure sore located on the sacrum. This code specifically pertains to the excision of the sore, which may involve removing damaged tissue and possibly some surrounding healthy tissue to ensure complete removal and promote healing. This procedure is often necessary for patients who have developed pressure sores due to prolonged immobility or other underlying health conditions.
For CPT code 15937, 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 increased intensity, time, technical difficulty, or physical and mental effort.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was conducted.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if the removal of the sacrum pressure sore is part of a staged or related procedure during the postoperative period of the initial surgery.
4. 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. This is particularly relevant if the procedure was carried out in a different session or involved a different site.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Apply this modifier if the same procedure needs to be repeated by the same physician or healthcare professional within a short period.
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
- This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period of the initial surgery.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure is unrelated to the original surgery and is performed by the same physician during the postoperative period.
8. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon is required to help with the procedure.
9. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon is necessary because a qualified resident surgeon is not available.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
These modifiers help provide additional context and specificity to the billing and coding process, ensuring accurate and appropriate reimbursement for the services rendered.
The CPT code 15937 is reimbursed by Medicare, but it is essential to verify the specifics 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 may have specific guidelines or requirements that need to be met for reimbursement.
Therefore, it is advisable to consult both the MPFS and your MAC to ensure compliance and accurate reimbursement for CPT code 15937.
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