CPT code 26160 is a medical code used to describe the procedure for removing a lesion from a tendon sheath.
CPT code 26170 is used for the surgical procedure involving the removal of a tendon from the palm of the hand. This code is specifically applied when a single tendon is being excised. This procedure may be necessary due to conditions such as tendon injuries, infections, or other abnormalities that affect hand function.
For CPT code 26170 (Removal of palm tendon each), the following modifiers may be applicable:
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 RT - Right Side: Indicates that the procedure was performed on the right hand.
5. Modifier LT - Left Side: Indicates that the procedure was performed on the left hand.
6. Modifier 22 - Increased Procedural Services: Used if the work required to perform the procedure is substantially greater than typically required.
7. Modifier 52 - Reduced Services: Applied when the procedure is partially reduced or eliminated at the physician's discretion.
8. Modifier 53 - Discontinued Procedure: Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
9. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the procedure was planned or anticipated (staged).
10. Modifier 76 - Repeat Procedure or Service by Same Physician: Used when the same procedure is repeated by the same physician.
11. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
12. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Indicates an unplanned return to the operating room for a related procedure.
13. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 26170 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this particular CPT code is covered and the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, it is essential to consult the local Medicare Administrative Contractor (MAC) for region-specific guidelines and coverage details. MACs are responsible for processing Medicare claims and can provide insights into any local coverage determinations (LCDs) that might affect the reimbursement of CPT code 26170. Therefore, while CPT code 26170 is generally reimbursed by Medicare, the exact reimbursement details should be verified through the MPFS and the relevant MAC.
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