CPT code 25630 is used for the treatment of a wrist bone fracture, detailing the specific medical procedure performed.
CPT code 25630 is used to describe the medical procedure for treating a wrist bone fracture. This code specifically refers to the closed treatment of a distal radial fracture, which means the fracture is managed without the need for surgical incision. The treatment typically involves methods such as casting or splinting to ensure proper alignment and healing of the wrist bone.
For CPT code 25630, which pertains to the treatment of a wrist bone fracture, the following modifiers may be applicable:
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 other factors that increase the complexity of the procedure.
2. Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period): 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): 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): Used if the procedure is performed on both wrists during the same session.
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 57 (Decision for Surgery): Used when an evaluation and management service 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): Used when a subsequent procedure is planned or anticipated, is more extensive than the original procedure, or is for therapy following a diagnostic surgical procedure.
13. 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.
14. Modifier 76 (Repeat Procedure or Service by Same Physician): Used when a procedure or service is repeated by the same physician.
15. Modifier 77 (Repeat Procedure by Another Physician): Used when a procedure or service is repeated by another 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 when a related procedure is performed during the postoperative period of the initial procedure.
17. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure or service is performed by the same physician during the postoperative period.
18. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
19. Modifier 81 (Minimum Assistant Surgeon): Used when a minimum assistant surgeon is required.
20. 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.
21. Modifier 99 (Multiple Modifiers): Used when two or more modifiers are necessary to describe the service.
Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement.
CPT code 25630 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this code is covered under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare. Additionally, it is essential to verify with the local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement rates for CPT code 25630.
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