CPT code 25500 is used for billing the treatment of a fractured radius, ensuring accurate medical billing and reimbursement.
CPT code 25505 is used to describe the medical procedure for treating a fracture of the radius, which is one of the two large bones in the forearm. This code specifically refers to the surgical intervention required to repair the broken bone, ensuring proper alignment and stabilization to promote healing. This may involve techniques such as setting the bone, using pins, plates, or screws, and possibly casting the arm to immobilize it during the recovery process.
When billing for CPT code 25505, which is used for the treatment of a fracture of the radius, certain modifiers may be required to provide additional information about the service rendered. Below is a list of potential modifiers that could be used with CPT code 25505, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could be due to the complexity of the fracture or additional time and effort needed.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Used if an unrelated E/M service is performed by the same physician during the postoperative period of the initial procedure.
3. Modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service): Used when a significant, separately identifiable E/M service is provided by the same physician on the same day as the procedure.
4. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both the left and right radius.
5. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same surgical session.
6. Modifier 52 (Reduced Services): Used when the service provided is less extensive than described in the CPT code.
7. Modifier 53 (Discontinued Procedure): Used if the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 54 (Surgical Care Only): Used when the physician performs the surgical procedure but does not provide preoperative or postoperative care.
9. Modifier 55 (Postoperative Management Only): Used when the physician provides only the postoperative care.
10. Modifier 56 (Preoperative Management Only): Used when the physician provides only the preoperative care.
11. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Used if a subsequent procedure is planned or staged during the postoperative period of the initial procedure.
12. 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.
13. Modifier 76 (Repeat Procedure or Service by Same Physician): Used if the same procedure is repeated by the same physician.
14. Modifier 77 (Repeat Procedure by Another Physician): Used if the same procedure is repeated by a different physician.
15. 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 if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
16. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
17. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required for the procedure.
18. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required.
19. 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.
20. Modifier 99 (Multiple Modifiers): Used when more than four modifiers are necessary to describe the service.
These modifiers help provide a more accurate description of the circumstances surrounding the procedure and ensure appropriate reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 25505 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, along with the corresponding reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 25505. It is essential for healthcare providers to consult both the MPFS and their respective MAC guidelines to ensure compliance and accurate reimbursement for this CPT code.
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