CPT code 25609 is for treating a radial fracture with three or more fragments.
CPT code 25611 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 the surgical intervention required to repair the fracture, ensuring proper alignment and stabilization of the bones to promote healing.
When billing for CPT code 25611, which pertains to the treatment of a fracture of the radius or ulna, certain modifiers may be necessary to provide additional information about the procedure. Below is a list of potential modifiers that could be used and the reasons for each:
1. Modifier 22 (Increased Procedural Services): Used when the work required to provide a service is substantially greater than typically required. This could apply if the fracture treatment was more complex than usual.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Applied if an unrelated E/M service is performed by the same physician during the postoperative period of the fracture treatment.
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 E/M service is provided by the same physician on the same day as the procedure.
4. Modifier 50 (Bilateral Procedure): If the procedure was performed on both the left and right radius/ulna, this modifier would be appropriate.
5. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This could be relevant if other procedures were performed in addition to the fracture treatment.
6. Modifier 52 (Reduced Services): Used when the procedure is partially reduced or eliminated at the physician's discretion.
7. Modifier 53 (Discontinued Procedure): Applied if the procedure was started but 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 only the surgical portion of the procedure and not the pre- or post-operative care.
9. Modifier 55 (Postoperative Management Only): Applied if the physician is providing only the postoperative care for the procedure.
10. Modifier 56 (Preoperative Management Only): Used when the physician provides only the preoperative care for the procedure.
11. Modifier 57 (Decision for Surgery): Applied if the E/M service resulted in the decision to perform the surgery.
12. Modifier 58 (Staged or Related Procedure or Service by the Same Physician During the Postoperative Period): Used if a subsequent procedure is planned or staged during the postoperative period of the initial procedure.
13. Modifier 59 (Distinct Procedural Service): Applied 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 if the same procedure is repeated by the same physician.
15. Modifier 77 (Repeat Procedure by Another Physician): Applied if the same procedure is repeated by a different 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 if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
17. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Applied if 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 for the procedure.
19. Modifier 81 (Minimum Assistant Surgeon): Applied if a minimum assistant surgeon is required.
20. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is required because a qualified resident surgeon is not available.
21. Modifier 99 (Multiple Modifiers): Applied when more than four modifiers are necessary to describe the service.
These modifiers help provide a more accurate and detailed description of the services rendered, ensuring proper billing and reimbursement.
The CPT code 25611 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs are responsible for processing Medicare claims and can offer detailed guidance on coverage and reimbursement criteria for CPT code 25611 in your specific region. Always consult the MPFS and your MAC to ensure accurate and up-to-date information regarding Medicare reimbursement for this code.
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