CPT code 25275 is for the surgical repair of a forearm tendon sheath, a procedure to restore tendon function and mobility.
CPT code 25280 is used to describe a surgical procedure that involves the revision of a tendon in the wrist or forearm. This code is typically utilized when a previous tendon repair or reconstruction needs to be corrected or modified due to complications, failure, or other issues. The procedure aims to restore proper function and alleviate pain or discomfort in the affected area.
When billing for CPT code 25280 (Revise wrist/forearm tendon), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer guidelines. Below is a list of potential modifiers that could be used with CPT code 25280, 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 procedure was performed on both wrists or forearms during the same surgical session.
3. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider.
4. Modifier 52 (Reduced Services):
- This modifier is appropriate 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 is 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 same procedure was repeated by a different physician on the same day.
8. Modifier 78 (Unplanned Return to the Operating/Procedure Room):
- This modifier is used if the patient requires a 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 of the initial procedure.
10. Modifier LT (Left Side):
- Use this modifier to specify that the procedure was performed on the left wrist or forearm.
11. Modifier RT (Right Side):
- Use this modifier to specify that the procedure was performed on the right wrist or forearm.
12. Modifier 80 (Assistant Surgeon):
- Apply this modifier if an assistant surgeon was required for the procedure.
13. Modifier 81 (Minimum Assistant Surgeon):
- Use this modifier if a minimum assistant surgeon was required for the procedure.
14. Modifier 82 (Assistant Surgeon when Qualified Resident Surgeon Not Available):
- This modifier is used if an assistant surgeon was necessary because a qualified resident surgeon was not available.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery):
- Apply this modifier if a non-physician practitioner assisted in the surgery.
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 policies for the most accurate and up-to-date information.
The CPT code 25280 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts. Additionally, reimbursement for CPT code 25280 may vary depending on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, healthcare providers should consult their respective MAC for precise information on reimbursement policies and rates for CPT code 25280.
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