CPT code 15952 is for the surgical removal of a pressure sore from the thigh, ensuring proper wound care and healing.
CPT code 15952 is used to describe the surgical procedure for the removal of a pressure sore (also known as a decubitus ulcer) located on the thigh. This code is specifically utilized when a healthcare provider performs an excision to remove the sore, which may involve the removal of surrounding damaged tissue to promote healing and prevent further complications. This procedure is often necessary for patients who have developed pressure sores due to prolonged immobility or other underlying health conditions.
For CPT code 15952, which pertains to the removal of a thigh pressure sore, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could be due to the complexity of the pressure sore removal.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both thighs, this modifier should be used to indicate that the service was performed bilaterally.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier is used to indicate that more than one procedure was performed.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: If the removal of the pressure sore is part of a staged procedure or related to the initial surgery, this modifier should be applied.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This could be relevant if the removal of the pressure sore is performed in conjunction with other unrelated procedures.
6. Modifier 76 - Repeat Procedure or Service by Same Physician: If the same procedure is repeated by the same physician, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier is applicable.
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: If the patient needs to return to the operating room for a related procedure during the postoperative period, this modifier should be used.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier is applicable.
10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be used.
11. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon provides minimal assistance during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): If an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon, this modifier should be applied.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these healthcare professionals assist in the surgery.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement for the services provided.
The CPT code 15952 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including their respective reimbursement rates.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may apply to CPT code 15952. The MACs are responsible for processing Medicare claims and can provide detailed guidance on the reimbursement process for this specific code.
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