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 25545 is used to describe the surgical treatment of a fracture of the ulna, which is one of the two long bones in the forearm. This code specifically refers to procedures where the bone is realigned and stabilized, often using hardware such as plates, screws, or rods, to ensure proper healing. This code is essential for accurate billing and documentation of the surgical intervention required to treat this type of fracture.
When billing for CPT code 25545, which is used for the treatment of a fracture of the ulna, certain modifiers may be required to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 25545, along with the reasons for their use:
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 provided 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 an evaluation and management service is performed on the same day as the procedure but is distinct and separately identifiable from 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 procedure 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 staged during the postoperative period of the initial 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 or Other Qualified Health Care Professional
- Used when a procedure or service is repeated by the same physician.
15. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Used when a procedure or service 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 patient returns to the operating room for a related procedure during the postoperative period.
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 and a qualified resident surgeon is not available.
21. Modifier 99 - Multiple Modifiers
- Used when two or more 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. It is essential to use the correct modifiers to avoid claim denials and ensure compliance with payer requirements.
The CPT code 25545 is reimbursed by Medicare, but the reimbursement specifics depend on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including CPT code 25545. However, the actual reimbursement amount can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) for your region. It is essential to consult the MPFS and your local MAC to obtain the precise reimbursement details for CPT code 25545.
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 25545. Schedule a demo today to see how RevFind can help you identify and recover revenue from individual payers.
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