CPT code 25360 is a medical code used to describe the surgical revision of the ulna, a bone in the forearm.
CPT code 25365 is a medical billing code used to describe the surgical procedure for revising the radius and ulna, which are the two long bones in the forearm. This code is used when a surgeon needs to correct or modify a previous surgery on these bones, often due to complications, improper healing, or other issues that require further intervention.
When billing for CPT code 25365 (Revise radius & 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 25365, 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 or difficulty.
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 are performed during the same surgical session. It indicates that the procedure is one of several performed.
4. Modifier 52 (Reduced Services):
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. Modifier 59 (Distinct Procedural Service):
- Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. It is used to avoid bundling issues.
6. Modifier 62 (Two Surgeons):
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure. Each surgeon should report their specific part of the surgery.
7. Modifier 66 (Surgical Team):
- This modifier is used when a team of surgeons is required to perform the procedure due to its complexity.
8. Modifier 76 (Repeat Procedure by Same Physician):
- Apply this modifier if the same physician needs to repeat the procedure on the same day.
9. Modifier 77 (Repeat Procedure by Another Physician):
- Use this modifier if a different physician repeats the procedure on the same day.
10. 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 when the patient requires a return to the operating room for a related procedure during the postoperative period.
11. 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.
12. Modifier 80 (Assistant Surgeon):
- Use this modifier when an assistant surgeon is required to assist with the procedure.
13. Modifier 81 (Minimum Assistant Surgeon):
- This modifier is used when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)):
- Apply this modifier when an assistant surgeon is necessary, and a qualified resident surgeon is not available.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery):
- Use this modifier when a non-physician provider assists in the surgery.
Proper use of these modifiers ensures accurate billing and helps avoid claim denials or delays. Always refer to the latest coding guidelines and payer-specific requirements for the most accurate and up-to-date information.
CPT code 25365 is reimbursed by Medicare, but the reimbursement specifics can vary. To determine the exact reimbursement rate, you should refer to the Medicare Physician Fee Schedule (MPFS), which provides detailed information on the payment rates for all covered services. Additionally, it's important to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific guidance on reimbursement policies and rates for CPT code 25365.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving accurate reimbursements for procedures like CPT code 25365. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
