CPT code 26135 is for the surgical revision of a finger joint, involving the correction or improvement of the joint's function.
CPT code 26135 is used to describe a surgical procedure that involves the revision of a finger joint. This means that a surgeon will perform an operation to correct or improve a previously performed surgery on a joint in the finger. This could involve removing scar tissue, adjusting the position of bones or implants, or other modifications to enhance joint function and reduce pain.
When using CPT code 26135 (Revise finger joint each), it is essential to consider the appropriate modifiers to ensure accurate billing and reimbursement. Below is a list of potential modifiers that could be used with CPT code 26135, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Used if the procedure is performed on both hands during the same operative session.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.
3. Modifier 59 - Distinct Procedural Service
- Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
- Applied if the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
- Used if the procedure is repeated by a different physician on the same day.
6. 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 returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used if an unrelated procedure is performed by the same physician during the postoperative period.
8. Modifier LT - Left Side
- Indicates that the procedure was performed on the left side of the body.
9. Modifier RT - Right Side
- Indicates that the procedure was performed on the right side of the body.
10. Modifier XS - Separate Structure
- Used to indicate that a service is distinct because it was performed on a separate organ/structure.
11. Modifier XE - Separate Encounter
- Applied when the procedure is distinct because it was performed during a separate encounter.
12. Modifier XP - Separate Practitioner
- Used when the procedure is distinct because it was performed by a different practitioner.
13. Modifier XU - Unusual Non-Overlapping Service
- Indicates that the service is distinct because it 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 26135 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage 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, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and reimbursement policies for CPT codes. Therefore, it is advisable to consult the relevant MAC for your region to ensure compliance with any specific guidelines or requirements that may affect the reimbursement of CPT code 26135.
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