CPT code 26025 is for the drainage of a palm bursa, a procedure to remove fluid from a swollen sac in the palm.
CPT code 26025 is used to describe the medical procedure for the drainage of a palm bursa. This involves a healthcare provider making an incision to drain fluid from a bursa located in the palm. A bursa is a small, fluid-filled sac that acts as a cushion between bones and soft tissues, and draining it can help relieve pain and reduce inflammation caused by conditions such as bursitis.
For CPT code 26025, which pertains to the drainage of a palm bursa, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or difficulty.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both hands during the same session, this modifier should be appended to indicate that it was a bilateral procedure.
3. Modifier 51 - Multiple Procedures: When multiple procedures are performed during the same surgical session, this modifier should be used to indicate that 26025 is one of several procedures.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the full service was not provided.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure was distinct or independent from other services performed on the same day. It is particularly useful when the procedure is not typically reported together with other services.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician on the same day, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician on the same day, this modifier should be used.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the procedure is performed during the postoperative period of another procedure but is unrelated to the original procedure, this modifier should be used.
10. Modifier LT - Left Side: If the procedure is performed on the left hand, this modifier should be used to specify the side.
11. Modifier RT - Right Side: If the procedure is performed on the right hand, this modifier should be used to specify the side.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 26025 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine the exact reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. Additionally, it is crucial to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and any local variations in reimbursement.
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