CPT code 25073 is for the excision of a deep tumor in the forearm, measuring 3 cm or more.
CPT code 25075 is used to describe the surgical procedure for excising (removing) a lesion from the forearm that is less than 3 centimeters in size. This code is specific to the forearm area and indicates that the lesion being removed is relatively small, measuring under 3 cm. This procedure is typically performed to remove abnormal tissue that could be benign or malignant, and the code helps in accurately documenting and billing for the surgical service provided.
When billing for CPT code 25075 (Excision of lesion of forearm and/or wrist; subcutaneous tissue, less than 3 cm), 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.
2. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both forearms during the same session.
3. Modifier 51 - Multiple Procedures: Use this modifier if multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Use this modifier if the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
6. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left forearm.
7. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right forearm.
8. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure is repeated by the same physician on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure is repeated by a different physician on the same day.
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 requires a 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: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon: Use this modifier if an assistant surgeon is required during the procedure.
13. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Use this modifier if an assistant surgeon is required and a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Use this modifier if a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 25075 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 coverage limitations, healthcare providers should consult the MPFS. Additionally, it is essential to verify with the respective Medicare Administrative Contractor (MAC) for any regional variations or additional guidelines that may affect reimbursement for CPT code 25075.
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 25075. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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