CPT code 25446 is a medical code used to describe the procedure for wrist replacement, aiding in billing and documentation for healthcare providers.
CPT code 25446 is used to describe the surgical procedure for a wrist replacement. This code is specifically assigned to the operation where a damaged or diseased wrist joint is replaced with an artificial implant. This procedure is typically performed to relieve pain and restore function in patients suffering from severe arthritis or other debilitating wrist conditions. By using CPT code 25446, healthcare providers can accurately document and bill for this specific type of wrist surgery.
When billing for CPT code 25446 (Wrist replacement), 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 25446, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the wrist replacement procedure required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the wrist replacement procedure was performed on both wrists during the same surgical session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including the wrist replacement, 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 if the wrist replacement procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if the wrist replacement is part of a staged or related procedure during the postoperative period of an initial surgery.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the wrist replacement procedure was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- This modifier is used when two surgeons work together as primary surgeons performing distinct parts of the wrist replacement procedure.
8. Modifier 66 - Surgical Team
- Apply this modifier if the wrist replacement procedure required a surgical team due to its complexity.
9. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the wrist replacement procedure had to be repeated by the same physician or healthcare professional.
10. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- This modifier is used if the wrist replacement procedure was repeated by a different physician or healthcare professional.
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
- Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period of the wrist replacement.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the wrist replacement.
13. Modifier 80 - Assistant Surgeon
- This modifier is used when an assistant surgeon is required to help with the wrist replacement procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required for the wrist replacement procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was necessary because a qualified resident surgeon was 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 wrist replacement surgery.
By appropriately applying these modifiers, healthcare providers can ensure accurate billing and optimize reimbursement for wrist replacement procedures.
The CPT code 25446 is reimbursed by Medicare, but the reimbursement specifics can vary. To determine if CPT 25446 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 under Medicare Part B. Additionally, it is essential to consult with your regional Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide guidance on any local coverage determinations or specific billing requirements related to CPT 25446.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving full reimbursement for procedures like CPT code 25446. 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
