CPT code 25565 is for treating fractures of the radius and ulna, detailing the specific medical procedure performed by healthcare providers.
CPT code 25565 is used to describe the surgical treatment of fractures in both the radius and ulna, which are the two long bones in the forearm. This code specifically pertains to procedures where the fractures are treated with internal fixation, meaning that hardware such as plates, screws, or rods is used to stabilize the bones and ensure proper healing. This type of surgery is typically performed by an orthopedic surgeon and is necessary when the fractures are severe or displaced, requiring precise alignment and stabilization to restore normal function.
When billing for CPT code 25565, which is used for the treatment of fractures of both the radius and 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 25565, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or the patient's condition.
2. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures were performed during the same surgical session. This helps to indicate that more than one procedure was carried out.
3. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. This could be due to patient-specific factors or intraoperative findings.
4. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if the procedure was planned or staged during the postoperative period of another procedure.
5. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Use this modifier if the same procedure was repeated by the same physician or healthcare professional.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Apply this modifier if the same procedure was repeated by a different physician or healthcare professional.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- This modifier is used if the patient had to return to the operating room unexpectedly for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure was performed by the same physician during the postoperative period of another procedure.
10. Modifier LT - Left Side
- Apply this modifier to indicate that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right side of the body.
12. Modifier 80 - Assistant Surgeon
- This modifier is used if an assistant surgeon was required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier if an assistant surgeon was required because a qualified resident surgeon was not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
Each of these modifiers provides specific information that can affect reimbursement and ensure accurate billing for the services rendered. It is crucial to use the appropriate modifiers to avoid claim denials and ensure proper payment.
CPT code 25565 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, the reimbursement for CPT code 25565 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret national policies and 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 for CPT code 25565.
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