CPT code 25645 is a medical code used to describe the treatment of a wrist bone fracture.
CPT code 25650 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. This could involve methods such as casting, splinting, or other non-invasive techniques to ensure proper alignment and healing of the wrist bone.
For CPT code 25650, which is used for the treatment of a wrist bone fracture, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Used when an evaluation and management service performed 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 an evaluation and management service is provided on the same day as the procedure but is distinct and separately identifiable from the procedure.
4. Modifier 50 - Bilateral Procedure: Used when the same procedure is performed on both sides of the body during the same operative 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 only and another provider is responsible for preoperative and 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 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 subsequent to the original procedure or service.
15. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician subsequent to the original procedure or service.
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 during the procedure.
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 provided.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 25650 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, along with the corresponding reimbursement rates. However, the final determination of reimbursement for CPT code 25650 may also depend on the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can have localized policies that affect whether and how a particular CPT code is reimbursed. Therefore, it is crucial to consult both the MPFS and your regional MAC to ensure accurate billing and reimbursement for CPT code 25650.
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