CPT code 25626 is a medical code used to describe the procedure for treating a fracture of the distal radius, typically involving surgical intervention.
CPT code 25628 is used to describe the surgical treatment of a wrist bone fracture. Specifically, this code refers to the procedure where the surgeon performs an open treatment of a distal radial fracture, which may involve internal fixation using pins, screws, or plates to stabilize the bone and ensure proper healing. This code is essential for accurate billing and documentation of the surgical intervention required to treat this type of wrist injury.
When billing for CPT code 25628, which is used for the treatment of a wrist bone fracture, certain modifiers may be required to provide additional information about the procedure. Below is a list of potential modifiers that could be used with CPT code 25628, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to the complexity of the fracture or patient-specific factors.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both wrists during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session. This helps indicate that more than one distinct procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure
- Apply this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same procedure was repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the procedure was repeated by a different physician on the same day.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period
- Use this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
11. Modifier LT - Left Side
- Apply this modifier if the procedure was performed on the left wrist.
12. Modifier RT - Right Side
- Use this modifier if the procedure was performed on the right wrist.
13. Modifier QX - CRNA Service: With Medical Direction by a Physician
- This modifier is used if a Certified Registered Nurse Anesthetist (CRNA) provided anesthesia services under the medical direction of a physician.
14. Modifier QY - Medical Direction of One CRNA by an Anesthesiologist
- Apply this modifier if an anesthesiologist provided medical direction for one CRNA.
15. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- Use this modifier if an anesthesiologist provided medical direction for two to four concurrent anesthesia procedures.
By using the appropriate modifiers, healthcare providers can ensure accurate billing and reimbursement for the services rendered.
The CPT code 25628 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding reimbursement rates. Additionally, the reimbursement for CPT code 25628 may vary depending on the local policies and guidelines set by the Medicare Administrative Contractor (MAC) for your region. It is essential to consult the MPFS and your regional MAC to determine the exact reimbursement details and any additional requirements that may apply.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Imagine identifying discrepancies for specific codes like 25628 with precision. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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
