CPT code 25392 is a medical code used to describe the surgical procedure to shorten the radius and ulna bones in the forearm.
CPT code 25392 is a medical billing code used to describe a surgical procedure that involves shortening the radius and ulna, which are the two long bones in the forearm. This procedure is typically performed to correct deformities, improve function, or alleviate pain in the forearm and wrist.
When billing for the CPT code 25392 (Shorten 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 modifiers that could be used with CPT code 25392, 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 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. This helps indicate that more than one procedure was carried out.
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. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
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 procedure.
7. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the same procedure is repeated by a different physician on the same day.
9. 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 an unplanned return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
11. Modifier LT - Left Side
- Apply this modifier to indicate that the procedure was performed on the left side of the body.
12. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right side of the body.
13. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required for 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 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
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
Proper use of these modifiers ensures that the billing accurately reflects the services provided, which can help in obtaining appropriate reimbursement and avoiding claim denials. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
CPT code 25392 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and guidelines for services covered under Medicare Part B. Additionally, the reimbursement for CPT code 25392 may vary depending on the local policies and guidelines set by the Medicare Administrative Contractor (MAC) for your region. It is essential to consult the MPFS and your respective MAC to ensure compliance with all billing and documentation requirements for successful reimbursement.
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