CPT code 25119 is for the partial removal of the ulna, a procedure involving the surgical excision of part of the forearm bone.
CPT code 25119 is used to describe the partial removal of the ulna, which is one of the two long bones in the forearm. This procedure involves surgically excising a portion of the ulna to address various medical conditions such as fractures, tumors, or other abnormalities that affect the bone. The goal of this surgery is to alleviate pain, restore function, and improve the overall health of the forearm.
When billing for CPT code 25119 (Partial removal of ulna), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 25119, 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. Documentation must support the increased complexity.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the partial removal of the ulna was performed on both arms during the same surgical session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including the partial removal of the ulna, are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply 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 physician performed the partial removal of the ulna more than once on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used if a different physician performed the partial removal of the ulna more than once 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
- Apply this modifier if the partial removal of the ulna was performed during the postoperative period of another, unrelated procedure.
10. Modifier LT - Left Side
- Use this modifier to specify that the procedure was performed on the left ulna.
11. Modifier RT - Right Side
- Use this modifier to specify that the procedure was performed on the right ulna.
12. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure accurate billing and optimal reimbursement for the partial removal of the ulna. Always refer to the latest coding guidelines and payer-specific requirements for the most accurate and up-to-date information.
CPT code 25119 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 the corresponding payment rates. To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS directly.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and providing guidance on Medicare coverage. Each MAC may have specific local coverage determinations (LCDs) that could affect the reimbursement of CPT code 25119. Therefore, it is advisable for healthcare providers to check with their respective MAC to ensure compliance with any regional policies or additional documentation requirements.
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 25119. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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