CPT code 15946 is a medical code used to describe the procedure for removing a hip pressure sore.
CPT code 15946 is used to describe the surgical procedure for the removal of a pressure sore located on the hip. This code is specifically utilized when a healthcare provider performs an excision to remove the damaged tissue caused by prolonged pressure, often seen in patients with limited mobility. The procedure aims to promote healing and prevent further complications such as infections.
When using CPT code 15946 for the removal of a hip 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): Used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the surgery.
2. Modifier 50 (Bilateral Procedure): Applied if the procedure is performed on both hips during the same surgical session.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier 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): Used if the removal of the hip pressure sore is part of a staged procedure or if additional related procedures are necessary during the postoperative period.
5. Modifier 59 (Distinct Procedural Service): Applied to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Used if the same procedure is repeated by the same provider within a short period.
7. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Applied if the procedure is 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): Used if the patient needs 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): Applied if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
10. Modifier LT (Left Side): Used to specify that the procedure was performed on the left hip.
11. Modifier RT (Right Side): Used to specify that the procedure was performed on the right hip.
12. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Used if an unrelated evaluation and management service is provided by the same physician during the postoperative period.
By understanding and appropriately applying these modifiers, healthcare providers can ensure accurate coding and optimal reimbursement for the removal of hip pressure sores.
The CPT code 15946 is reimbursed by Medicare, but it is essential to verify the specific details 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. Additionally, the MAC for your region can offer more precise information regarding any local coverage determinations or specific billing requirements for CPT code 15946.
Always ensure to check these resources to confirm the most current and applicable reimbursement guidelines.
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