CPT code 26116 is for the excision of a deep hand tumor less than 1.5 cm in size.
CPT code 26117 is used for the surgical procedure involving the radical resection of a tumor in the hand that is less than 3 centimeters in size. This code is specifically applied when a surgeon removes a tumor from the hand, ensuring that the excision is thorough and aims to eliminate all cancerous or abnormal tissue.
When billing for CPT code 26117 (Radical resection of tumor, soft tissue of hand or finger; less than 3 cm), 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 26117, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. Documentation must support the increased complexity or time.
2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both hands or fingers during the same session, this modifier should be appended to indicate a bilateral procedure.
3. Modifier 51 (Multiple Procedures): When multiple procedures are performed during the same surgical session, this modifier indicates that multiple services were provided.
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 service provided was less than usually required.
5. Modifier 59 (Distinct Procedural Service): Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is particularly important if the procedures are not typically reported together but are appropriate under the circumstances.
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 to indicate the repeat service.
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 requires an unplanned 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): Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT (Left Side): If the procedure is performed on the left hand or finger, this modifier should be appended to specify the location.
11. Modifier RT (Right Side): If the procedure is performed on the right hand or finger, this modifier should be appended to specify the location.
12. Modifier XS (Separate Structure): This modifier is used to indicate that a service is distinct because it was performed on a separate organ/structure.
13. Modifier XE (Separate Encounter): Use this modifier to indicate that a service is distinct because it was performed during a separate encounter.
14. Modifier XP (Separate Practitioner): This modifier is used to indicate that a service is distinct because it was performed by a different practitioner.
15. Modifier XU (Unusual Non-Overlapping Service): Use this modifier to indicate that a service is distinct because it does not overlap usual components of the main service.
Proper use of these modifiers ensures that the billing accurately reflects the services provided and helps avoid claim denials or delays in reimbursement. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
CPT code 26117 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 26117. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining local coverage decisions. Each MAC may have specific guidelines and policies that can affect the reimbursement of CPT code 26117. Therefore, it is essential for healthcare providers to consult their respective MAC for the most accurate and up-to-date information regarding the reimbursement of this code.
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