CPT code 25415 is a medical code used to describe the surgical repair of the radius and ulna bones in the forearm.
CPT code 25420 is used for the surgical procedure involving the repair or grafting of the radius and ulna, which are the two long bones in the forearm. This code is typically utilized when a patient requires surgical intervention to fix fractures, defects, or other issues affecting these bones, ensuring proper alignment and function.
For CPT code 25420 (Repair/graft radius & ulna), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure is performed on both the left and right sides of the body 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 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. 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 distinct operative work.
7. Modifier 66 - Surgical Team
- This modifier is used when a complex procedure requires the services of several physicians, often of different specialties, working together as a team.
8. Modifier 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same physician performs the procedure again on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performs the procedure again 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 returns to the operating room for a related procedure during the postoperative period of the initial surgery.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when 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 help with the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- This modifier is used when an assistant surgeon provides minimal assistance during the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier when an assistant surgeon is required because 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 practitioner assists in the surgery.
Each modifier serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association (AMA) and payer-specific policies. Proper use of modifiers ensures accurate coding and appropriate reimbursement for the services provided.
CPT code 25420 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT 25420 is covered and the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is crucial to consult with the local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific guidance on coverage and reimbursement for CPT 25420.
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