CPT code 25230 is for the partial removal of the radius, a procedure often performed to treat fractures or other bone conditions.
CPT code 25240 is used to describe the surgical procedure for the partial removal of the ulna, which is one of the two long bones in the forearm. This code is utilized by healthcare providers to document and bill for the specific service of excising a portion of the ulna, typically to address conditions such as fractures, tumors, or other abnormalities that affect the bone.
When billing for CPT code 25240 (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 25240, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the additional effort.
2. Modifier 50 (Bilateral Procedure): Applied if the procedure is performed on both ulnas during the same operative session.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
4. Modifier 52 (Reduced Services): Applied when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 (Distinct Procedural Service): Used to indicate that the procedure is distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician): Applied when the same procedure is 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): Used when the patient returns 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): Applied 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 specify that the procedure was performed on the left ulna.
11. Modifier RT (Right Side): Used 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): Applied when a non-physician provider assists in the surgery.
13. Modifier GC (Service Performed in Part by a Resident Under the Direction of a Teaching Physician): Used when a resident performs the procedure under the supervision of a teaching physician.
14. Modifier QX (CRNA Service with Medical Direction by a Physician): Applied when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia services under the medical direction of a physician.
15. Modifier QY (Medical Direction of One CRNA by an Anesthesiologist): Used when an anesthesiologist provides medical direction for one CRNA.
16. Modifier QK (Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals): Applied when an anesthesiologist provides medical direction for multiple anesthesia procedures.
Proper use of these modifiers ensures that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
CPT code 25240 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any potential coverage limitations, healthcare providers should consult the MPFS, which provides detailed information on payment rates for services covered under Medicare Part B. Additionally, it is essential to verify with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide guidance on any local coverage determinations or specific billing requirements associated with CPT code 25240.
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