CPT code 26123 is a medical code used to describe the surgical procedure for releasing a contracture in the palm.
CPT code 26125 is used to describe a surgical procedure that involves the release of a contracture in the palm. This procedure is typically performed to alleviate restricted movement and improve functionality in the hand by addressing tightened or shortened tissues that limit motion.
When billing for CPT code 26125 (Release palm contracture), it is essential 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 26125, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Used when 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. This modifier indicates that the procedure is one of several performed.
3. Modifier 59 - Distinct Procedural Service
- Used to indicate that the procedure is distinct or independent from other services performed on the same day. This is particularly relevant if another procedure is performed on a different site or through a separate incision.
4. Modifier LT - Left Side
- Indicates that the procedure was performed on the left hand.
5. Modifier RT - Right Side
- Indicates that the procedure was performed on the right hand.
6. Modifier 22 - Increased Procedural Services
- Used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the increased complexity.
7. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Applied if the procedure is planned or staged, or if it is more extensive than the original procedure.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Used when the same procedure is repeated by the same provider on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Indicates that the same procedure is repeated by a different provider on the same day.
10. 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 if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Applied when an unrelated procedure is performed by the same provider during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- Indicates that an assistant surgeon was necessary for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Used when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Applied when an assistant surgeon is necessary because a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Indicates that a non-physician provider assisted in the surgery.
Proper use of these modifiers ensures 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 26125 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and determining coverage specifics in their respective jurisdictions. Therefore, it is advisable to consult the MPFS and the relevant MAC for precise information on the reimbursement for CPT code 26125.
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