CPT code 15945 is a medical code used to document the surgical removal of a hip pressure sore for billing and insurance purposes.
CPT code 15945 is used to describe the surgical procedure for the removal of a pressure sore located on the hip. This code is specifically assigned to the medical service where a healthcare provider surgically excises the pressure ulcer, which may include the removal of surrounding infected or dead tissue to promote healing and prevent further complications.
When using CPT code 15945 for the removal of a hip 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 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both hips during the same session.
3. 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.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the procedure was planned or anticipated at the time of the original procedure, or if it was more extensive than the original procedure.
5. 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 is often used to avoid bundling issues.
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 physician or healthcare professional.
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 physician or healthcare professional.
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 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 the procedure was unrelated to the original procedure and was performed during the postoperative period.
10. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used if an assistant surgeon was required for a minimal portion of the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
The CPT code 15945 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, it is essential to verify the specific reimbursement details with your regional Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide precise information on coverage and payment policies for CPT code 15945.
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