CPT code 25535 is a medical code used to describe the treatment of a fractured ulna, which is one of the bones in the forearm.
CPT code 25535 is used to describe the medical procedure for treating a fracture of the ulna, which is one of the two long 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.
When billing for CPT code 25535, which is used for the treatment of a fracture of the ulna, 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 25535, 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 same 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 only the surgical portion of the service is provided.
9. Modifier 55 - Postoperative Management Only
- Used when only the postoperative care is provided.
10. Modifier 56 - Preoperative Management Only
- Used when only the preoperative care is provided.
11. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Used when 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 or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by the same physician.
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.
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 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 multiple modifiers are necessary to describe the service provided.
These modifiers help to provide a more complete picture of the services rendered and ensure accurate billing and reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 25535 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare and can be accessed through the Centers for Medicare & Medicaid Services (CMS) website. Additionally, reimbursement for CPT code 25535 may vary depending on the region, as Medicare Administrative Contractors (MACs) have jurisdiction over local coverage determinations and payment policies. Therefore, it is advisable to consult the relevant MAC for your geographic area to obtain precise information on the reimbursement rates and any specific billing requirements for CPT code 25535.
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