CPT code 25607 is for treating a radial fracture that is extra-articular, meaning the break does not extend into the joint.
CPT code 25607 is used to describe the treatment of a fracture in the radius bone, specifically when the fracture is extra-articular. This means that the break in the bone does not extend into the joint surface. The procedure typically involves the surgical repair of the fracture to ensure proper alignment and healing of the bone.
For CPT code 25607, which pertains to the treatment of a radial fracture that is extra-articular, the following modifiers may be applicable:
1. Modifier 22 (Increased Procedural Services): This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): This modifier is 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): This modifier is 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): This modifier is used if the procedure is performed on both sides of the body.
5. Modifier 51 (Multiple Procedures): This modifier is used when multiple procedures are performed during the same surgical session.
6. Modifier 52 (Reduced Services): This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 (Discontinued Procedure): This modifier is 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): This modifier is used when one physician performs the surgical care and another provides preoperative and/or postoperative management.
9. Modifier 55 (Postoperative Management Only): This modifier is used when one physician performs the postoperative management and another physician has performed the surgical procedure.
10. Modifier 56 (Preoperative Management Only): This modifier is used when one physician performs the preoperative care and evaluation and another physician performs the surgical procedure.
11. Modifier 57 (Decision for Surgery): This modifier is used when an evaluation and management service provided the day before or the day of surgery 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): This modifier is used for a staged or related procedure by the same physician during the postoperative period.
13. Modifier 59 (Distinct Procedural Service): This modifier is 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): This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional.
15. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional.
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): This modifier is used when a related procedure is performed during the postoperative period.
17. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
18. Modifier 80 (Assistant Surgeon): This modifier is used when an assistant surgeon is required during the procedure.
19. Modifier 81 (Minimum Assistant Surgeon): This modifier is used when a minimum assistant surgeon is required during the procedure.
20. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): This modifier is used when an assistant surgeon is required and a qualified resident surgeon is not available.
21. Modifier 99 (Multiple Modifiers): This modifier is used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
The CPT code 25607 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines 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. To determine the exact reimbursement amount for CPT code 25607, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and ensuring that they comply with Medicare policies and guidelines. They may have local coverage determinations (LCDs) that provide further details on the conditions under which CPT code 25607 is reimbursed. Therefore, it is essential for healthcare providers to consult their respective MACs to understand any specific requirements or documentation needed for successful reimbursement of CPT code 25607.
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