CPT code 25605 is for treating a fracture of the radius or ulna, detailing the specific medical procedure performed for accurate billing and documentation.
CPT code 25606 is used to describe the treatment of a distal radial fracture. This code specifically refers to the surgical procedure where the fracture at the end of the radius bone near the wrist is repaired. The treatment typically involves the use of internal fixation, such as plates and screws, to stabilize the bone and ensure proper healing. This code is essential for accurately documenting and billing for the surgical intervention required to treat this type of fracture.
When billing for CPT code 25606, which is used for the treatment of a distal radial fracture, certain modifiers may be necessary to provide additional information about the service rendered. Below is a list of potential modifiers that could be used with CPT code 25606 and 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. 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): 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 a significant, separately identifiable evaluation and management service is performed on the same day as the procedure.
4. Modifier 50 (Bilateral Procedure): Used if 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 but does not provide preoperative or 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 for a staged or related procedure 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): Used when a procedure or service is repeated by the same physician.
15. Modifier 77 (Repeat Procedure by Another Physician): 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 related procedure is performed during the postoperative period of the initial procedure.
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 complete picture of the services rendered and ensure accurate billing and reimbursement. Always consult the latest CPT coding guidelines and payer-specific policies to confirm the appropriate use of modifiers.
The CPT code 25606 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, healthcare providers should consult their respective MAC for precise information regarding the reimbursement of CPT code 25606.
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 25606. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
