CPT code 26215 is a medical code used to describe the removal or grafting of a lesion on a finger.
CPT code 26230 is used to describe the partial removal of a bone in the hand. This procedure involves surgically excising a portion of one of the bones in the hand, which may be necessary due to conditions such as tumors, infections, or severe fractures that cannot be treated through other means. The goal of this surgery is to alleviate pain, remove diseased tissue, and restore as much function as possible to the hand.
For CPT code 26230, which pertains to the partial removal of a hand bone, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both hands during the same operative session, this modifier should be appended.
3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: If the same procedure is repeated by the same physician, this modifier should be used.
7. Modifier 77 - Repeat Procedure by Another Physician: If the procedure is repeated by a different physician, this modifier should be appended.
8. Modifier 78 - Unplanned Return to the Operating Room: If the patient requires an unplanned return to the operating room for a related procedure during the postoperative period, this modifier should be used.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.
10. Modifier LT - Left Side: If the procedure is performed on the left hand, this modifier should be used to specify the side.
11. Modifier RT - Right Side: If the procedure is performed on the right hand, this modifier should be used to specify the side.
12. Modifier XS - Separate Structure: Use this modifier to indicate that the procedure was performed on a separate organ/structure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 26230 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 reimbursement rates. Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may apply to the reimbursement of CPT code 26230. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies for this particular code.
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