CPT code 25118 is a medical code used to describe the procedure of excising a tendon sheath in the wrist.
CPT code 25118 is used to describe the surgical procedure of excising, or removing, a tendon sheath in the wrist. This procedure is typically performed to relieve pain or improve function when the tendon sheath becomes inflamed or thickened, often due to conditions like tenosynovitis. By removing the problematic sheath, the surgeon aims to alleviate symptoms and restore normal tendon movement.
When billing for CPT code 25118 (Excision of wrist tendon sheath), it is important to consider the appropriate use of modifiers to ensure accurate reimbursement and to reflect the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with CPT code 25118, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure was performed on both wrists during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session.
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
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if the same 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
- Use this modifier if the patient required an unplanned 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
- Use 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 indicate that the procedure was performed on the left wrist.
11. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right wrist.
12. Modifier XS - Separate Structure
- Use this modifier to indicate that the procedure was performed on a separate anatomical structure.
13. Modifier XE - Separate Encounter
- Use this modifier to indicate that the procedure was performed during a separate encounter on the same day.
14. Modifier XP - Separate Practitioner
- Use this modifier to indicate that the procedure was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service
- Use this modifier to indicate that the procedure does not overlap usual components of the main service.
Proper use of these modifiers can help ensure that the claim is processed correctly and that the healthcare provider receives appropriate reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific policies for the most accurate and up-to-date information.
The CPT code 25118 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, the reimbursement for CPT code 25118 may vary depending on the local policies set by the Medicare Administrative Contractor (MAC) for your region. It is essential to consult the MPFS and your local MAC guidelines to determine the exact reimbursement details and any additional requirements that may apply.
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