CPT code 25065 is a medical code used to describe a biopsy procedure of the soft tissues in the forearm.
CPT code 25065 is used to describe a medical procedure where a biopsy is taken from the soft tissues of the forearm. This involves the removal of a small sample of tissue for examination, typically to diagnose a condition or to check for abnormalities. This code is specific to the forearm area and focuses on the soft tissues, which include muscles, tendons, and other connective tissues.
When billing for CPT code 25065 (Biopsy, soft tissue of forearm), it is essential to determine if any modifiers are necessary to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 25065, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the biopsy procedure required significantly more work than typically required. This could be due to factors such as patient anatomy or the complexity of the biopsy.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the biopsy was performed on both forearms during the same surgical session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session, including the biopsy of the forearm soft tissues.
4. Modifier 59 - Distinct Procedural Service
- This modifier is used to indicate that the biopsy procedure was distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the biopsy procedure was repeated by the same provider on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the biopsy procedure was repeated by a different provider on the same day.
7. 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.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if the biopsy was performed during the postoperative period of another procedure but is unrelated to the initial surgery.
9. Modifier LT - Left Side
- Use this modifier to specify that the biopsy was performed on the left forearm.
10. Modifier RT - Right Side
- Apply this modifier to indicate that the biopsy was performed on the right forearm.
11. Modifier GA - Waiver of Liability Statement Issued as Required by Payer Policy
- Use this modifier if an Advance Beneficiary Notice (ABN) was issued to the patient, indicating that the patient may be responsible for payment if the payer denies the claim.
12. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician
- Apply this modifier if the biopsy was performed by a resident under the supervision of a teaching physician.
By appropriately using these modifiers, healthcare providers can ensure accurate billing and reimbursement for the biopsy of forearm soft tissues.
CPT code 25065 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should refer to the MPFS, which provides detailed information on the payment policies and rates for services covered by Medicare. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement for CPT code 25065.
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