CPT code 26235 is for the partial removal of a finger bone, used for medical billing and documentation in healthcare services.
CPT code 26236 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 conditions such as fractures, infections, or tumors that cannot be treated through less invasive methods. The goal of this surgery is to alleviate pain, restore function, and prevent further complications in the affected finger.
For CPT code 26236 (Partial removal of finger bone), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both hands.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: Used if the procedure was planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
6. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure or Service by Same Physician: Used if the procedure needs to be repeated by the same physician.
8. Modifier 77 - Repeat Procedure by Another Physician: Used if the procedure needs to be repeated by a different physician.
9. 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 needs to return to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if the procedure is unrelated to the original procedure and is performed during the postoperative period.
11. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the body.
12. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the body.
13. Modifier XS - Separate Structure: Used to indicate that a service is distinct because it was performed on a separate organ/structure.
14. Modifier XE - Separate Encounter: Used to indicate that a service is distinct because it was performed during a separate encounter.
15. Modifier XP - Separate Practitioner: Used to indicate that a service is distinct because it was performed by a different practitioner.
16. Modifier XU - Unusual Non-Overlapping Service: Used to indicate that a service is distinct because it does not overlap usual components of the main service.
These modifiers help provide additional information about the procedure and ensure accurate billing and reimbursement. Always consult the latest CPT coding guidelines and payer-specific requirements to determine the appropriate use of modifiers.
The CPT code 26236 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC). The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 26236. Additionally, MACs can offer region-specific insights and any additional requirements or documentation needed for successful reimbursement. Always ensure to stay updated with the latest MPFS and MAC guidelines to optimize your revenue cycle management.
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