CPT code 25119 is for the partial removal of the ulna, a surgical procedure involving the excision of part of the forearm bone.
CPT code 25120 is used for the surgical procedure involving the removal of a lesion from the forearm. This code specifically denotes that a healthcare provider has performed an excision to remove an abnormal growth or tissue from the forearm area. The procedure is typically done to diagnose or treat conditions such as tumors, cysts, or other abnormal tissue formations.
When billing for CPT code 25120 (Removal of forearm lesion), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer guidelines. Below is a list of modifiers that could be used with CPT code 25120, along with the reasons for their use:
1. Modifier -50 (Bilateral Procedure): Used if the removal of lesions is performed on both forearms during the same surgical session.
2. Modifier -51 (Multiple Procedures): Applied when multiple procedures, including the removal of forearm lesions, are performed during the same operative session.
3. Modifier -59 (Distinct Procedural Service): Used to indicate that the removal of the forearm lesion is a distinct procedure from other services performed on the same day.
4. Modifier -RT (Right Side): Indicates that the procedure was performed on the right forearm.
5. Modifier -LT (Left Side): Indicates that the procedure was performed on the left forearm.
6. Modifier -22 (Increased Procedural Services): Applied if the procedure required significantly more work than usual, such as in cases of extensive lesions or complications.
7. Modifier -76 (Repeat Procedure by Same Physician): Used if the same procedure is repeated by the same physician on the same day.
8. Modifier -77 (Repeat Procedure by Another Physician): Applied if the same procedure is repeated by a different physician on the same day.
9. Modifier -78 (Unplanned Return to the Operating Room): Used if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
10. Modifier -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that the removal of the forearm lesion is unrelated to the original procedure performed during the postoperative period.
11. Modifier -80 (Assistant Surgeon): Applied if an assistant surgeon is required during the procedure.
12. Modifier -81 (Minimum Assistant Surgeon): Used if a minimum assistant surgeon is required during the procedure.
13. Modifier -82 (Assistant Surgeon when Qualified Resident Surgeon Not Available): Applied if an assistant surgeon is required because a qualified resident surgeon is not available.
14. Modifier -99 (Multiple Modifiers): Used when more than four modifiers are necessary to describe the procedure accurately.
By appropriately applying these modifiers, healthcare providers can ensure that their claims for CPT code 25120 are processed correctly, leading to accurate reimbursement and compliance with payer requirements.
The CPT code 25120 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 potential coverage limitations for CPT code 25120, healthcare providers should consult the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 25120. Providers should verify with their respective MAC to ensure compliance with local coverage determinations and any additional documentation requirements that may apply.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving accurate reimbursements for procedures like CPT code 25120. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
