CPT code 25608 is for treating a fracture of the radius bone within the joint.
CPT code 25608 is used to describe the surgical treatment of a fracture in the radius bone, specifically when the fracture extends into the joint (intra-articular). This code is typically used when a healthcare provider performs an open treatment, which means making an incision to access the fracture site, and may involve the use of internal fixation devices such as plates or screws to stabilize the bone and ensure proper healing.
For CPT code 25608 (Treatment of distal radial intra-articular fracture), the following modifiers may be applicable depending on the specific circumstances of the procedure:
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 additional time and effort.
2. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier indicates that the procedure is one of several performed.
3. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 (Discontinued Procedure): Applied when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 54 (Surgical Care Only): Used when the physician performs the surgical procedure but does not provide preoperative or postoperative care.
6. Modifier 55 (Postoperative Management Only): Applied when the physician provides only the postoperative care for the procedure.
7. Modifier 56 (Preoperative Management Only): Used when the physician provides only the preoperative care for the procedure.
8. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Applied when a subsequent procedure is planned or staged during the postoperative period of the initial procedure.
9. 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.
10. Modifier 62 (Two Surgeons): Applied when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
11. 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 or other qualified healthcare professional.
12. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Applied when a procedure or service is repeated by another physician or other qualified healthcare professional.
13. 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 requires a return to the operating room for a related procedure during the postoperative period.
14. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied when a procedure or service performed during the postoperative period is unrelated to the original procedure.
15. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
16. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required during the procedure.
17. 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.
18. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Applied when a non-physician practitioner assists in the surgery.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 25608 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should refer to the MPFS. Additionally, it is essential to consult with the respective Medicare Administrative Contractor (MAC) for the region, as MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and any local variations that may apply.
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