CPT code 25390 is a medical code used to describe the surgical procedure to shorten the radius or ulna bones in the forearm.
CPT code 25391 is used to describe a surgical procedure where the radius or ulna, which are the two long bones in the forearm, is lengthened. This procedure is typically performed to correct deformities, improve function, or address discrepancies in bone length that may result from congenital conditions, trauma, or other medical issues. The code ensures that the specific nature of the surgery is accurately documented for billing and insurance purposes.
For CPT code 25391 (Lengthen radius or ulna), 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 the left and right sides during the same 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 53 - Discontinued Procedure: Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team: Used when a highly complex procedure is carried out by a surgical team.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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: Used when a related procedure is performed during the postoperative period of the initial procedure.
12. 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.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required, and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Used when these non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT guidelines and payer-specific policies for the most accurate and up-to-date information.
The CPT code 25391 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 25391 may vary based on the policies of the Medicare Administrative Contractor (MAC) responsible for your geographic region. Each MAC has the authority to interpret Medicare guidelines and may have specific local coverage determinations (LCDs) that impact reimbursement. Therefore, it is advisable to consult both the MPFS and your regional MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 25391.
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