CPT code 25126 is a medical code used to describe the procedure for removing and grafting a lesion on the forearm.
CPT code 25130 is used to describe the surgical procedure for the removal of a lesion from the wrist. This code is utilized by healthcare providers to document and bill for the specific service of excising a growth or abnormal tissue from the wrist area, ensuring accurate and standardized reporting for insurance claims and medical records.
For CPT code 25130 (Removal of wrist lesion), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly greater effort than typically required.
2. Modifier 50 - Bilateral Procedure: Apply 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: This modifier is applicable 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: Apply 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 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 needs 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 is performed by the same physician during the postoperative period.
10. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left wrist.
11. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right wrist.
12. Modifier XS - Separate Structure: Use this modifier to indicate that a service was performed on a separate organ/structure.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT guidelines and payer-specific requirements when applying modifiers.
CPT code 25130 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT 25130 is covered and the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT 25130.
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