CPT code 26045 is a medical code used to describe the procedure for releasing a palm contracture.
CPT code 26055 is used to describe a medical procedure where a surgeon makes an incision in the sheath of a tendon in the finger. This procedure is typically performed to relieve pressure or to treat conditions such as trigger finger, where the tendon sheath becomes inflamed and restricts movement. By incising the tendon sheath, the surgeon aims to restore normal function and alleviate pain.
For the CPT code 26055 (Incise finger tendon sheath), 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 perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both hands.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. 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.
7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure 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 when the patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
11. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the body.
12. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the body.
13. Modifier XS - Separate Structure: Used to indicate a service that is distinct because it was performed on a separate organ/structure.
14. Modifier XE - Separate Encounter: Used to indicate a service that is distinct because it occurred during a separate encounter.
15. Modifier XP - Separate Practitioner: Used to indicate a service that is distinct because it was performed by a different practitioner.
16. Modifier XU - Unusual Non-Overlapping Service: Used to indicate a service that is distinct because it does not overlap usual components of the main service.
These modifiers help provide additional information about the performed procedure, ensuring accurate billing and appropriate reimbursement. Always refer to the latest CPT coding guidelines and payer-specific requirements for the most accurate application of modifiers.
CPT code 26055 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 and the corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 26055 may also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can have localized coverage determinations that affect whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 26055.
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