CPT code 25335 is for the surgical realignment of the hand, a procedure to correct deformities or improve function.
CPT code 25337 is used for the surgical procedure to reconstruct the ulna or the radioulnar joint. This code is specifically applied when a surgeon performs a complex operation to repair or rebuild the ulna bone in the forearm or the joint between the radius and ulna bones. This type of surgery is often necessary due to trauma, congenital deformities, or degenerative conditions that affect the stability and function of the forearm and wrist.
When billing for CPT code 25337 (Reconstruct ulna/radioulnar), 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 25337, 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. This could be due to factors such as increased complexity or unusual patient anatomy.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both the left and right sides during the same operative 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 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team
- This modifier is used when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician subsequent to the original procedure.
10. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the same procedure was repeated by another physician subsequent to the original procedure.
11. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient requires a return to the operating room for a related procedure during the postoperative period.
12. 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.
13. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required to assist the primary surgeon during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is necessary because a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a non-physician provider assists in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure accurate coding, which is crucial for proper reimbursement and compliance with payer guidelines.
The CPT code 25337 is subject to reimbursement by Medicare, but its eligibility and the amount reimbursed are determined by the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided to Medicare beneficiaries. Additionally, the specific reimbursement details for CPT code 25337 can vary based on the region and the Medicare Administrative Contractor (MAC) responsible for processing claims in that area. It is essential to consult the MPFS and the relevant MAC guidelines to ascertain the precise reimbursement status and rate for CPT code 25337.
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 25337. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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
