CPT code 250 is a medical code used to describe a specific procedure or service for billing and documentation purposes in healthcare.
CPT code 25000 is used to describe a medical procedure involving the incision of a tendon sheath. This procedure is typically performed to relieve pressure, reduce inflammation, or treat conditions such as tenosynovitis, where the sheath surrounding a tendon becomes swollen and painful. By making an incision in the tendon sheath, the surgeon can alleviate symptoms and improve the patient's range of motion and comfort.
For the CPT code 25000 (Incision of tendon sheath), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
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.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by another 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: Used when a related procedure is performed during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
10. Modifier LT - Left Side: Used to indicate that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right side of the body.
12. Modifier XS - Separate Structure: Used to indicate a service that is distinct because it was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter: Used to indicate a service that is distinct because it occurred during a separate encounter.
14. Modifier XP - Separate Practitioner: Used to indicate a service that is distinct because it was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service: Used to indicate a service that is distinct because it does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 25000 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 25000, while the MAC can offer region-specific guidelines and any additional requirements that may apply. Always consult these resources to ensure accurate and up-to-date information regarding Medicare reimbursement for CPT code 25000.
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