CPT code 25620 is used for billing the treatment of a fracture in the radius or ulna, which are bones in the forearm.
CPT code 25620 is used to describe the medical procedure for treating a fracture of the radius and/or ulna, which are the two long bones in the forearm. This code is typically used by healthcare providers to document and bill for the surgical repair or treatment of these types of fractures.
When billing for CPT code 25620 (Treatment of fracture of radius and/or ulna), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 25620, along with 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 apply if the fracture treatment was unusually complex.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): Used if an unrelated E/M service is performed 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 if a significant, separately identifiable E/M service is provided on the same day as the fracture treatment.
4. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both the left and right 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 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.
12. 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.
13. Modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional): Used if the same procedure is repeated by the same physician.
14. Modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional): Used if the same procedure is repeated by a different physician.
15. 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 a return to the operating room for a related procedure during the postoperative period.
16. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used if an unrelated procedure is performed by the same physician during the postoperative period.
17. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
18. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required.
19. 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.
20. Modifier 99 (Multiple Modifiers): Used when multiple modifiers are necessary to describe the service provided.
By appropriately applying these modifiers, healthcare providers can ensure accurate coding, billing, and reimbursement for the treatment of fractures of the radius and/or ulna.
The CPT code 25620 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, which provides detailed information on the payment policies and rates for various CPT codes. Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide further clarification on coverage and reimbursement specifics for CPT code 25620.
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 25620. 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
