CPT code 26255 is for extensive hand surgery, covering procedures that involve complex repairs or reconstructions of hand structures.
CPT code 26255 is used to describe an extensive hand surgery procedure. This code is specifically assigned to surgeries that involve significant reconstruction or repair of the hand, addressing complex issues such as severe injuries, deformities, or conditions that require intricate surgical techniques. This code helps healthcare providers and insurance companies accurately document and bill for the specialized care provided during these comprehensive hand surgeries.
When billing for CPT code 26255 (Extensive hand surgery), 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 26255, along with the reasons for their use:
1. Modifier 22 (Increased Procedural Services)
- Use this modifier if the hand surgery was significantly more complex or required more time than usual.
2. Modifier 50 (Bilateral Procedure)
- Apply this modifier if the extensive hand surgery was performed on both hands during the same operative session.
3. Modifier 51 (Multiple Procedures)
- Use this modifier when multiple procedures, including the extensive hand surgery, are performed during the same surgical session.
4. Modifier 52 (Reduced Services)
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 53 (Discontinued Procedure)
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threatened the well-being of the patient.
6. Modifier 59 (Distinct Procedural Service)
- Apply this modifier to indicate that the extensive hand surgery was distinct or independent from other services performed on the same day.
7. Modifier 62 (Two Surgeons)
- Use this modifier if two surgeons were required to perform the extensive hand surgery due to its complexity.
8. Modifier 66 (Surgical Team)
- Apply this modifier if the procedure required a surgical team due to its complexity.
9. Modifier 76 (Repeat Procedure by Same Physician)
- Use this modifier if the same physician performed the extensive hand surgery more than once on the same day.
10. Modifier 77 (Repeat Procedure by Another Physician)
- Apply this modifier if a different physician performed the extensive hand surgery more than once on the same day.
11. 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 required an unplanned return to the operating room for a related procedure during the postoperative period.
12. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial surgery.
13. Modifier 80 (Assistant Surgeon)
- Use this modifier if an assistant surgeon was necessary for the extensive hand surgery.
14. Modifier 81 (Minimum Assistant Surgeon)
- Apply this modifier if a minimum assistant surgeon was required for the procedure.
15. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available))
- Use this modifier if an assistant surgeon was necessary due to the unavailability of a qualified resident surgeon.
16. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- Use this modifier if a physician assistant, nurse practitioner, or clinical nurse specialist assisted in the surgery.
By appropriately applying these modifiers, healthcare providers can ensure accurate billing and optimal reimbursement for CPT code 26255.
The CPT code 26255 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts. Additionally, reimbursement for CPT code 26255 may vary depending on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to confirm the reimbursement details for CPT code 26255.
Discover how MD Clarity's RevFind software can read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're getting paid accurately for procedures like CPT code 26255. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
