CPT code 26145 is for the surgical excision of a tendon in the palm or finger, used for accurate medical billing and documentation.
CPT code 26145 is used to describe the surgical procedure for the excision, or removal, of a tendon from the palm or finger. This code is specifically utilized when a healthcare provider performs a surgery to remove a damaged or diseased tendon in these areas, which may be necessary due to conditions such as tendonitis, injury, or other tendon-related issues.
When billing for CPT code 26145 (Tendon excision palm/finger), 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 26145, 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.
2. Modifier 50 (Bilateral Procedure):
- Apply this modifier if the tendon excision was performed on both hands or both fingers during the same surgical session.
3. Modifier 51 (Multiple Procedures):
- Use this modifier when multiple procedures, other than E/M services, are performed at the same session by the same provider. This helps indicate that multiple procedures were performed.
4. Modifier 52 (Reduced Services):
- This modifier is used if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should support 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 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 returns to the operating room for a related procedure during the postoperative period of the initial surgery.
9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period):
- Apply this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial surgery.
10. Modifier LT (Left Side):
- Use this modifier to specify that the procedure was performed on the left side of the body.
11. Modifier RT (Right Side):
- Apply this modifier to specify that the procedure was performed on the right side of the body.
12. Modifier XS (Separate Structure):
- Use this modifier to indicate that a service was performed on a separate organ/structure.
13. Modifier XE (Separate Encounter):
- Apply this modifier to indicate that a service was performed during a separate encounter.
14. Modifier XP (Separate Practitioner):
- Use this modifier to indicate that a service was performed by a different practitioner.
15. Modifier XU (Unusual Non-Overlapping Service):
- Apply this modifier to indicate that the service 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 26145 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 26145. Additionally, MACs may have specific guidelines or requirements that could affect reimbursement. Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 26145.
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