CPT code 26113 is for the surgical removal of a deep tumor in the hand that is 1.5 cm or smaller.
CPT code 26115 is used to describe a surgical procedure involving the excision of a lesion from the hand that is less than 1.5 centimeters in size. This code is specific to the removal of small, potentially problematic growths or abnormalities from the hand, ensuring precise documentation and billing for the procedure.
When billing for CPT code 26115 (Excision of lesion of the hand or finger, subcutaneous tissue; less than 1.5 cm), it is important to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of modifiers that could be used with CPT code 26115, along with the reasons for their use:
1. Modifier -50 (Bilateral Procedure): Used if the procedure is performed on both hands during the same session.
2. Modifier -51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session.
3. Modifier -52 (Reduced Services): Used if the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier -59 (Distinct Procedural Service): Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier -RT (Right Side): Used to specify that the procedure was performed on the right hand.
6. Modifier -LT (Left Side): Used to specify that the procedure was performed on the left hand.
7. Modifier -XS (Separate Structure): Indicates that the procedure was performed on a separate organ/structure.
8. Modifier -XU (Unusual Non-Overlapping Service): Used when the service does not overlap usual components of the main service.
9. Modifier -GA (Waiver of Liability Statement Issued as Required by Payer Policy): Indicates that an Advance Beneficiary Notice (ABN) is on file for a service that may not be covered.
10. Modifier -GY (Item or Service Statutorily Excluded or Does Not Meet the Definition of Any Medicare Benefit): Used when the service is not covered by Medicare.
11. Modifier -GZ (Item or Service Expected to Be Denied as Not Reasonable and Necessary): Indicates that no ABN was issued for a service expected to be denied.
12. Modifier -22 (Increased Procedural Services): Used when the work required to provide the service is substantially greater than typically required.
13. Modifier -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Applied if the patient needs to return to the operating room for a related procedure during the postoperative period.
14. 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.
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 26115 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to ensure compliance with local coverage determinations and any specific billing requirements that may apply. Each MAC may have unique guidelines and policies that could impact the reimbursement process for CPT code 26115.
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