CPT code 25170 is a medical billing code used to describe the surgical procedure for resecting a tumor from the radius or ulna.
CPT code 25210 is used for the surgical procedure involving the removal of a bone from the wrist. This code is specifically designated for cases where a bone in the wrist needs to be excised due to conditions such as severe arthritis, fractures, or other medical issues that necessitate the removal to alleviate pain or restore function.
For CPT code 25210 (Removal of wrist bone), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both wrists during the same operative session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
7. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side: Used to indicate that the procedure was performed on the left wrist.
11. Modifier RT - Right Side: Used to indicate that the procedure was performed on the right wrist.
12. Modifier XS - Separate Structure: Used to indicate that a service is distinct because it was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter: Used to indicate that a service is distinct because it was performed during a separate encounter.
14. Modifier XP - Separate Practitioner: Used to indicate that a service is distinct because it was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service: Used to indicate that a service is distinct because it does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always consult the latest CPT coding guidelines and payer-specific requirements to determine the appropriate use of modifiers.
CPT code 25210 is reimbursed by Medicare, but the specifics of reimbursement can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 25210. However, the final determination of reimbursement is often made by the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and reimbursement rates for CPT code 25210. It is advisable to consult the MPFS and your local MAC to confirm the exact reimbursement details for this code.
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 25210. Schedule a demo today to see how RevFind can help you identify and recover every dollar you're owed from each payer.
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
