CPT code 26117 is used for the surgical removal of a tumor in the hand that is less than 3 cm in size.
CPT code 26118 is used to describe the surgical procedure for the radical resection of a tumor in the hand that measures up to 3 centimeters. This code is specifically utilized when a surgeon removes a tumor from the hand, ensuring that the excision is thorough and includes a margin of healthy tissue around the tumor to minimize the risk of recurrence. This procedure is typically performed to treat malignant or benign tumors that could affect the function or health of the hand.
When billing for CPT code 26118 (Radical resection of tumor, soft tissue of hand or finger; 3 cm or greater), it is important to consider the appropriate use of modifiers to ensure accurate reimbursement and to reflect the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with CPT code 26118, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services):
- Use this modifier if the procedure required significantly greater effort or complexity than typically required. Documentation must support the increased complexity.
2. Modifier 50 (Bilateral Procedure):
- Apply this modifier if the procedure was performed on both hands during the same surgical session.
3. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures are performed during the same surgical session. This indicates that the primary procedure was accompanied by additional procedures.
4. Modifier 52 (Reduced Services):
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should explain the reason for the reduction.
5. Modifier 59 (Distinct Procedural Service):
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 76 (Repeat Procedure by Same Physician):
- Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 (Repeat Procedure by Another Physician):
- Apply this modifier if the same procedure was repeated by a different physician on the same day.
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):
- Use this modifier if the patient required 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):
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT (Left Side):
- Use this modifier to indicate that the procedure was performed on the left hand.
11. Modifier RT (Right Side):
- Apply this modifier to indicate that the procedure was performed on the right hand.
12. Modifier XS (Separate Structure):
- Use this modifier to indicate that the procedure was performed on a separate organ/structure from other procedures performed on the same day.
13. Modifier XE (Separate Encounter):
- Apply this modifier if the procedure was performed during a separate encounter on the same day as other procedures.
14. Modifier XP (Separate Practitioner):
- Use this modifier if the procedure was performed by a different practitioner on the same day as other procedures.
15. Modifier XU (Unusual Non-Overlapping Service):
- Apply this modifier to indicate that the procedure does not overlap usual components of the main service.
Proper use of these modifiers can help ensure that claims are processed correctly and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.
The CPT code 26118 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable coverage limitations, healthcare providers should consult the MPFS. Additionally, it is essential to verify with the relevant Medicare Administrative Contractor (MAC) for any regional variations or additional requirements that may affect reimbursement for CPT code 26118.
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