CPT code 25929 is for amputation follow-up surgery, detailing the specific medical procedure for accurate billing and documentation.
CPT code 25929 is used to describe a surgical procedure that involves follow-up surgery after an amputation. This code is specifically utilized when a patient requires additional surgical intervention to address complications, improve the residual limb, or prepare the limb for a prosthetic device. This could include procedures such as revising the amputation site, removing scar tissue, or correcting any issues that have arisen since the initial amputation.
For CPT code 25929 (Amputation follow-up surgery), 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 apply if the follow-up surgery is more complex than usual.
2. Modifier 50 - Bilateral Procedure: Used if the follow-up surgery is performed on both limbs.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the service provided is less than usually required for the listed procedure.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used if the follow-up surgery is planned or staged during the postoperative period of the initial amputation.
6. Modifier 59 - Distinct Procedural Service: Used to indicate that the follow-up surgery is distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Used if the follow-up surgery needs to be repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used if the follow-up surgery is repeated by a different physician.
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: Used if the follow-up surgery is unplanned and related to the initial amputation.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if the follow-up surgery is unrelated to the initial amputation and occurs during the postoperative period.
11. Modifier 80 - Assistant Surgeon: Used if an assistant surgeon is required during the follow-up surgery.
12. Modifier 81 - Minimum Assistant Surgeon: Used if a minimum assistant surgeon is required during the follow-up surgery.
13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used if an assistant surgeon is required and a qualified resident surgeon is not available.
14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used if a non-physician provider assists in the follow-up surgery.
These modifiers help provide additional information about the circumstances of the procedure, ensuring accurate billing and reimbursement.
CPT code 25929 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should refer to the MPFS, which provides detailed information on the payment policies and rates for services covered by Medicare. Additionally, it is crucial to consult the local Medicare Administrative Contractor (MAC) for any region-specific rules or additional documentation requirements that may affect reimbursement. The MAC is responsible for processing Medicare claims and can provide further guidance on the nuances of billing for CPT code 25929.
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. For instance, if you're billing for CPT code 25929, RevFind ensures you're receiving the full reimbursement you're entitled to. Schedule a demo today to see how RevFind can optimize your revenue cycle and safeguard your practice's financial health.
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
