CPT code 26230 is for the partial removal of a hand bone, used by healthcare providers for billing and documentation purposes.
CPT code 26235 is used to describe the partial removal of a bone in the finger. This procedure involves surgically excising a portion of one of the bones in the finger, typically to address issues such as infection, tumors, 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 affected finger.
When billing for CPT code 26235 (Partial removal of finger bone), 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 26235, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
- Used if the procedure is performed on both hands.
2. Modifier 51 - Multiple Procedures
- Applied when multiple procedures are performed during the same surgical session.
3. Modifier 52 - Reduced Services
- Used if the procedure is partially reduced or eliminated at the physician's discretion.
4. Modifier 59 - Distinct Procedural Service
- Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician
- Used if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
- Applied if the same procedure is repeated by a different physician on the same day.
7. 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 returns to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that the procedure is unrelated to the original procedure and performed during the postoperative period.
9. Modifier LT - Left Side
- Used to specify that the procedure was performed on the left side of the body.
10. Modifier RT - Right Side
- Used to specify that the procedure was performed on the right side of the body.
11. Modifier XS - Separate Structure
- Indicates that the service is distinct because it was performed on a separate organ/structure.
12. Modifier XE - Separate Encounter
- Used to indicate that the service is distinct because it was performed during a separate encounter.
13. Modifier XP - Separate Practitioner
- Indicates that the service is distinct because it was performed by a different practitioner.
14. Modifier XU - Unusual Non-Overlapping Service
- Used to indicate 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 policies when applying modifiers.
The CPT code 26235 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT code 26235 is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare. Additionally, it is essential to check with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and any local coverage determinations (LCDs) that may affect reimbursement.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 26235. Schedule a demo today to see how RevFind can help you identify and recover every dollar you're owed from each payer.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
