CPT code 25575 is for the treatment of a fracture in the radius or ulna, which are the bones in the forearm.
CPT code 25600 is used to describe the medical procedure for treating a fracture of the radius or ulna, which are the two long bones in the forearm. This code specifically refers to a closed treatment, meaning the fracture is managed without surgical incision, typically using methods like casting or splinting to ensure proper alignment and healing.
For CPT code 25600, which pertains to the treatment of a fracture of the radius or ulna, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could be due to complications or other factors that increase the complexity of the procedure.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Applied if an evaluation and management service is performed during the postoperative period of the initial procedure, but is unrelated to the initial 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 by the same physician on the same day as the procedure.
4. Modifier 50 (Bilateral Procedure): Applied if the procedure is performed on both the left and right sides of the body during the same session.
5. Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during the same session. This modifier indicates that the procedures are distinct and separate from one another.
6. Modifier 52 (Reduced Services): Applied 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 started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
8. Modifier 54 (Surgical Care Only): Applied when the physician performs only the surgical portion of the procedure, and another provider is responsible for preoperative and postoperative care.
9. Modifier 55 (Postoperative Management Only): Used when the physician is responsible only for the postoperative care of the patient.
10. Modifier 56 (Preoperative Management Only): Applied when the physician is responsible only for the preoperative care of the patient.
11. 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.
12. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Applied when a procedure or service is repeated by the same physician or other qualified healthcare professional.
13. 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 qualified healthcare professional.
14. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Applied when the patient returns to the operating room for a related procedure during the postoperative period.
15. 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 of the initial procedure.
16. Modifier 80 (Assistant Surgeon): Applied when an assistant surgeon is required during the procedure.
17. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required during the procedure.
18. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Applied when an assistant surgeon is required, and a qualified resident surgeon is not available.
19. Modifier 99 (Multiple Modifiers): Used when two or more modifiers are necessary to describe the service provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 25600 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. However, it is important to note that the final determination of reimbursement for CPT code 25600 may also depend on the guidelines and policies set forth by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and ensuring compliance with Medicare regulations, which can vary by locality. Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 25600.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 25600. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from each payer.
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