CPT code 25915 is a medical code used to describe the surgical procedure for the amputation of the forearm.
CPT code 25920 is used to describe the surgical procedure of amputating a hand at the wrist. This code is utilized by healthcare providers to document and bill for the removal of the hand through the wrist joint, typically due to severe injury, infection, or other medical conditions that necessitate such an intervention.
When billing for the CPT code 25920 (Amputate hand at wrist), 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 25920, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Use this modifier if the procedure is performed on both wrists during the same surgical session.
2. Modifier 51 - Multiple Procedures
- Apply this modifier if multiple procedures are performed during the same surgical session, including the amputation of the hand at the wrist.
3. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the amputation procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
- This modifier is used if the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the procedure is repeated by a different physician on the same day.
6. 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 returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- This modifier is used if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
8. Modifier LT - Left Side
- Apply this modifier if the procedure is performed on the left wrist.
9. Modifier RT - Right Side
- Use this modifier if the procedure is performed on the right wrist.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- This modifier is used when a physician assistant, nurse practitioner, or clinical nurse specialist assists in the surgery.
11. Modifier GC - Service Performed in Part by a Resident Under the Direction of a Teaching Physician
- Apply this modifier if the procedure is performed in part by a resident under the supervision of a teaching physician.
12. Modifier QX - CRNA Service: with Medical Direction by a Physician
- Use this modifier if a Certified Registered Nurse Anesthetist (CRNA) performs the anesthesia service under the medical direction of a physician.
13. Modifier QK - Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals
- This modifier is used if the physician is directing multiple anesthesia procedures concurrently.
14. Modifier QS - Monitored Anesthesia Care Service
- Apply this modifier if monitored anesthesia care is provided during the procedure.
15. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than usual.
By correctly applying these modifiers, healthcare providers can ensure that their claims are processed accurately and that they receive appropriate reimbursement for the services rendered.
The CPT code 25920 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs are responsible for processing Medicare claims and can offer more localized information regarding coverage and reimbursement specifics for CPT code 25920. Always consult these resources to ensure accurate and up-to-date information.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 25920, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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