CPT code 25515 is used to describe the treatment of a radius fracture, ensuring accurate billing and documentation for healthcare providers.
CPT code 25520 is used to describe the medical procedure for treating a fracture of the radius, which is one of the two bones in the forearm. This code specifically refers to the closed treatment of a radial shaft fracture, meaning the bone is realigned without the need for surgical incision. This procedure typically involves the use of casting or splinting to ensure proper healing and alignment of the bone.
When billing for CPT code 25520, which is used for the treatment of a fracture of the radius, various modifiers may be required to provide additional information about the procedure. Below is a list of potential modifiers that could be used and the reasons for each:
1. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Used when an evaluation and management service performed during the postoperative period is unrelated to the original 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 evaluation and management service is performed on the same day as the procedure.
4. Modifier 50 - Bilateral Procedure
- Used when the procedure is performed on both sides of the body.
5. Modifier 51 - Multiple Procedures
- Used when multiple procedures are performed during the same surgical session.
6. Modifier 52 - Reduced Services
- Used when the procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure
- Used when the procedure is 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 care only and another provider is responsible for preoperative and 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 57 - Decision for Surgery
- Used when an evaluation and management service results in the initial decision to perform the surgery.
12. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Used when a subsequent procedure is planned or anticipated, is more extensive than the original procedure, or is for therapy following a diagnostic surgical procedure.
13. 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.
14. Modifier 76 - Repeat Procedure or Service by Same Physician
- Used when the same procedure is repeated by the same physician.
15. Modifier 77 - Repeat Procedure by Another Physician
- Used when the same procedure is repeated by another physician.
16. 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 when a related procedure is performed during the postoperative period of the initial procedure.
17. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when an unrelated procedure is performed by the same physician during the postoperative period.
18. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
19. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
20. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Used when an assistant surgeon is required because a qualified resident surgeon is not available.
21. Modifier 99 - Multiple Modifiers
- Used when multiple modifiers are necessary to describe the service provided.
These modifiers help provide a more complete picture of the services rendered and ensure accurate billing and reimbursement. Always refer to the latest CPT and payer guidelines to confirm the appropriate use of modifiers.
CPT code 25520 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, the reimbursement for CPT code 25520 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is essential to consult the relevant MAC for your region to confirm the specific reimbursement details and any additional requirements that may apply.
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 25520. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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
