CPT code 25112 is a medical code used to describe the procedure for removing a lesion from a wrist tendon.
CPT code 25115 is used to describe the surgical procedure for the removal of a lesion from the wrist or forearm. This code is specifically assigned to indicate that a healthcare provider has performed an excision to remove an abnormal growth or tissue in these areas. The procedure typically involves making an incision, carefully excising the lesion, and then closing the wound. This code helps in accurately documenting and billing for the surgical service provided.
When billing for CPT code 25115 (Remove wrist/forearm lesion), it is essential to consider whether any modifiers are required to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 25115, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 (Bilateral Procedure): If the procedure was performed on both wrists or forearms during the same session, this modifier should be appended.
3. Modifier 51 (Multiple Procedures): Apply this modifier if multiple procedures were performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 52 (Reduced Services): Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 (Distinct Procedural Service): This modifier is used to indicate that the 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.
6. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure was repeated by the same physician on the same day, this modifier should be used.
7. Modifier 77 (Repeat Procedure by Another Physician): Use this modifier if the procedure was repeated by a different physician on the same day.
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 had 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): Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT (Left Side): Use this modifier to specify that the procedure was performed on the left wrist or forearm.
11. Modifier RT (Right Side): Use this modifier to specify that the procedure was performed on the right wrist or forearm.
12. Modifier XS (Separate Structure): This modifier is used to indicate that the procedure was performed on a separate organ/structure.
13. Modifier XE (Separate Encounter): Use this modifier if the procedure was performed during a separate encounter on the same day.
14. Modifier XP (Separate Practitioner): This modifier is used when the procedure was performed by a different practitioner.
15. Modifier XU (Unusual Non-Overlapping Service): Apply this modifier to indicate that the procedure does not overlap usual components of the main service.
By appropriately using these modifiers, healthcare providers can ensure accurate billing and avoid potential issues with claims processing.
The CPT code 25115 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of fees that Medicare pays for each service, including CPT code 25115. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement rate and any specific billing requirements for CPT code 25115.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level and by individual payer. Imagine effortlessly identifying discrepancies for procedures like CPT code 25115. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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
