CPT code 15958 is a medical billing code used to describe the surgical removal of a pressure sore from the thigh.
CPT code 15958 is used to describe the surgical procedure for the removal of a pressure sore located on the thigh. This code is specifically assigned to the medical service where a healthcare provider surgically excises the damaged tissue caused by prolonged pressure, often seen in patients with limited mobility. The goal of this procedure is to promote healing and prevent further complications associated with pressure sores.
For CPT code 15958, which pertains to the removal of a thigh pressure sore, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures
- Apply this modifier when multiple procedures are performed during the same surgical session. This indicates that more than one procedure was performed on the same patient on the same day.
3. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure.
5. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when a procedure is repeated by another physician or other qualified healthcare professional subsequent to the original procedure.
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
- Apply this modifier if the patient requires a 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 when an unrelated procedure or service is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for the procedure. It indicates that another surgeon assisted in the procedure.
9. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when an assistant surgeon is required for a minimal portion of the procedure.
10. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
11. 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.
Each of these modifiers serves a specific purpose and should be used according to the specific circumstances of the procedure to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
The CPT code 15958 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 and their corresponding reimbursement rates. Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm coverage and any regional variations in reimbursement policies. The MACs are responsible for processing Medicare claims and can provide detailed information on the reimbursement criteria for CPT code 15958.
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