CPT code 25635 is used for treating a wrist bone fracture, detailing the specific medical procedure performed for accurate billing and documentation.
CPT code 25635 is used to describe the surgical treatment of a wrist bone fracture. This code specifically refers to the procedure where the surgeon performs an open treatment of a distal radial fracture, which may involve internal fixation. This means that the surgeon makes an incision to access the fracture site and uses hardware, such as plates or screws, to stabilize the broken bone and ensure proper healing. This code is essential for accurate billing and documentation of the surgical intervention required to treat a wrist fracture.
When billing for CPT code 25635, which pertains to the treatment of a wrist bone fracture, it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of modifiers that could be used with CPT code 25635, 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. Documentation must support the substantial additional work and the reason for it.
2. Modifier 50 (Bilateral Procedure): Used if the procedure is performed on both wrists during the same session. This modifier indicates that the same procedure was performed on a mirror-image anatomical site.
3. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This helps in identifying that more than one procedure was carried out.
4. Modifier 52 (Reduced Services): Used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. Modifier 53 (Discontinued Procedure): Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 54 (Surgical Care Only): Indicates that the physician performed the surgical procedure only, and another provider will provide preoperative and/or postoperative management.
7. Modifier 55 (Postoperative Management Only): Used when the physician or other qualified healthcare professional is providing only the postoperative care.
8. Modifier 56 (Preoperative Management Only): Applied when the physician or other qualified healthcare professional is providing only the preoperative care.
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. This is often used to identify procedures that are not typically reported together but are appropriate under the circumstances.
10. Modifier 76 (Repeat Procedure by Same Physician): Used when the same procedure is repeated by the same physician subsequent to the original procedure.
11. Modifier 77 (Repeat Procedure by Another Physician): Applied when the same procedure is repeated by a different physician subsequent to the original procedure.
12. 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.
13. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Indicates that an unrelated procedure or service was performed by the same physician during the postoperative period of the initial procedure.
14. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.
15. Modifier 81 (Minimum Assistant Surgeon): Applied when a minimum assistant surgeon is required during the procedure.
16. 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.
17. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery): Indicates that a non-physician practitioner assisted in the surgery.
Proper use of these modifiers ensures that the billing accurately reflects the services provided, which is crucial for appropriate reimbursement and compliance with payer policies. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 25635 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 detailed information on the reimbursement rates for various CPT codes, including 25635, and any applicable guidelines or restrictions. Additionally, MACs may have localized policies or additional requirements that could impact reimbursement. Therefore, it is advisable to consult both the MPFS and your MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 25635.
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