CPT code 59515 is for a cesarean delivery, covering the procedure and postpartum care provided to the patient.
CPT code 59515 is used to describe a cesarean delivery procedure that includes postpartum care. This code is specifically utilized when a cesarean section is performed, and the healthcare provider also manages the patient's care during the postpartum period. This comprehensive code ensures that both the surgical delivery and the follow-up care after childbirth are accounted for in the billing process. It is important for healthcare providers to use this code accurately to ensure proper reimbursement for the full scope of services provided during and after the cesarean delivery.
For CPT code 59515, which pertains to cesarean delivery including postpartum care, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide the service is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the cesarean delivery.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is used if the physician provides an evaluation and management service during the postpartum period that is unrelated to the cesarean delivery.
3. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is applicable if a significant, separately identifiable evaluation and management service is performed on the same day as the cesarean delivery.
4. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the cesarean delivery was one of several procedures.
5. 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 may be applicable if the cesarean delivery is performed in conjunction with other procedures that are not typically performed together.
6. Modifier 76 - Repeat Procedure or Service by Same Physician: This modifier is used if the cesarean delivery is repeated by the same physician for the same patient.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used if the cesarean delivery is repeated by a different physician.
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 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: This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the cesarean delivery.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the cesarean delivery.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required because a qualified resident surgeon is not available.
13. Modifier 90 - Reference (Outside) Laboratory: This modifier is used if laboratory services are performed by a party other than the treating or reporting physician.
14. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances of the cesarean delivery and ensure accurate billing and reimbursement.
CPT code 59515 is reimbursed by Medicare, as it is included in the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided to Medicare beneficiaries, and CPT 59515 is listed as a reimbursable service. However, the reimbursement rate and coverage specifics can vary based on geographic location and other factors. These details are determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a particular region. Healthcare providers should consult their local MAC for precise reimbursement information and any additional requirements that may apply to CPT code 59515.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With RevFind, you can effortlessly read your contracts and detect underpayments down to the CPT code level, such as CPT code 59515, and by individual payer. Don't leave money on the table—schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
