CPT code 25525 is used for billing the treatment of a radius fracture, ensuring accurate documentation and reimbursement for healthcare providers.
CPT code 25526 is used to describe the surgical treatment of a fracture of the radius, which is one of the two bones in the forearm. This code specifically refers to procedures where the fracture is repaired using internal fixation, such as plates, screws, or rods, to stabilize the bone and ensure proper healing. This type of procedure is typically performed by an orthopedic surgeon and may be necessary when the fracture is severe or displaced, requiring precise alignment and stabilization to restore function and prevent complications.
When billing for CPT code 25526, 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 25526, 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.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
- Used when an evaluation and management service provided during a 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 a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 - Discontinued Procedure
- Used when a 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 performs only the postoperative management and another provider has performed the surgical procedure.
10. Modifier 56 - Preoperative Management Only
- Used when the physician performs only the preoperative care and evaluation and another provider performs the surgical procedure.
11. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Used when a procedure or service during the postoperative period was planned or anticipated (staged).
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 or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
14. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by another physician or other qualified healthcare professional.
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 when a patient returns 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 when an unrelated procedure or service is performed by the same physician during the postoperative period.
17. Modifier 80 - Assistant Surgeon
- Used when an assistant surgeon is required during the procedure.
18. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required during the procedure.
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 two or more 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 consult the latest CPT coding guidelines and payer-specific requirements to ensure proper use of modifiers.
The CPT code 25526 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 reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 25526. 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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