CPT code 49215 is used to describe the excision of a tumor located in the sacral spine, detailing the specific surgical procedure performed.
CPT code 49215 is used to describe the surgical procedure for excising a tumor located in the sacral spine. This code indicates that the healthcare provider has performed a surgical removal of a tumor from the sacral region, which is the triangular bone at the base of the spine, just above the tailbone. This procedure may be necessary to treat conditions such as tumors that could be benign or malignant, and it typically involves careful dissection to ensure complete removal while preserving surrounding structures.
For CPT code 49215, which pertains to the excision of a sacral spine tumor, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed bilaterally.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons were required to perform the procedure together.
7. Modifier 66 - Surgical Team
- Apply this modifier if the procedure required a surgical team due to its complexity.
8. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the procedure again within a short period.
9. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician performed the procedure again within a short period.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period.
12. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply 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 under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 49215 is reimbursed by Medicare. The code is listed on the Medicare Physician Fee Schedule (MPFS), which indicates that it is a covered service. However, coverage and payment may vary depending on the specific Medicare Administrative Contractor (MAC) in your region. It's important to verify with your local MAC for any specific coverage guidelines or documentation requirements associated with this code.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 49215. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
