CPT code 25450 is a medical code used to describe the surgical revision of a wrist joint.
CPT code 25455 is for the surgical procedure involving the revision of a wrist joint. This means that a surgeon performs a corrective operation on a previously operated wrist joint to address issues such as complications, improper healing, or to improve the function and alignment of the joint. This code is used to document and bill for the specific service provided during the revision surgery.
For CPT code 25455, which pertains to the revision of the wrist joint, 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. This could be due to factors such as increased complexity or time.
2. Modifier 50 (Bilateral Procedure): Applied if the revision of the wrist joint is performed on both wrists during the same surgical session.
3. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session. This modifier indicates that the revision of the wrist joint is one of several procedures.
4. Modifier 52 (Reduced Services): Applied if the 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): Used if the revision of the wrist joint is part of a staged or related procedure during the postoperative period of the initial surgery.
6. Modifier 59 (Distinct Procedural Service): Used to indicate that the revision of the wrist joint is a distinct procedure from other services performed on the same day.
7. Modifier 62 (Two Surgeons): Applied if two surgeons are required to perform the revision of the wrist joint due to its complexity.
8. Modifier 66 (Surgical Team): Used when the procedure requires a surgical team due to its complexity.
9. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Applied if the same physician performs the revision of the wrist joint more than once on the same day.
10. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Used if a different physician performs the revision of the wrist joint more than once on the same day.
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): Applied if the patient needs to return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used if the revision of the wrist joint is performed during the postoperative period of another, unrelated procedure.
13. Modifier 80 (Assistant Surgeon): Applied if an assistant surgeon is required to perform the revision of the wrist joint.
14. Modifier 81 (Minimum Assistant Surgeon): Used if a minimum assistant surgeon is required for the procedure.
15. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied if an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.
16. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Used when a non-physician provider assists in the surgery.
Each of these modifiers provides additional information that can affect billing and reimbursement, ensuring that the specifics of the procedure are accurately communicated to payers.
CPT code 25455 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. Additionally, the reimbursement for CPT code 25455 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 regional MAC to determine the exact reimbursement details and any potential limitations or requirements for this specific CPT code.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 25455. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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
