CPT code 26260 is a medical code used to describe the surgical procedure for resecting a tumor from the proximal finger.
CPT code 26260 is used to describe the surgical procedure for resecting a tumor located in the proximal phalanx of a finger. This code is specifically for the removal of a tumor from the bone in the first segment of the finger, closest to the hand. The procedure involves surgically excising the tumor to prevent its spread and alleviate any associated symptoms.
When billing for CPT code 26260 (Resect proximal finger tumor), 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 26260, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly more work than typically required. This could be due to factors such as increased complexity or time.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure was performed on both hands during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Apply 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
- Use this modifier if the same procedure was repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- This modifier is used when the same procedure is repeated by a different physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating Room
- Apply this modifier if the patient had to return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side
- This modifier is used to specify that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- This modifier is used to specify that the procedure was performed on the right side of the body.
12. Modifier XS - Separate Structure
- Apply this modifier to indicate that a service was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter
- Use this modifier to indicate that a service was performed during a separate encounter.
14. Modifier XP - Separate Practitioner
- This modifier is used to indicate that a service was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service
- Apply this modifier to indicate that a service does not overlap usual components of the main service.
By correctly applying these modifiers, healthcare providers can ensure that their claims for CPT code 26260 are processed accurately and efficiently, leading to appropriate reimbursement and compliance with payer guidelines.
The CPT code 26260 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs play a crucial role in determining local coverage decisions and may have specific guidelines or requirements for the reimbursement of CPT code 26260. Therefore, it is advisable to consult both the MPFS and your MAC to ensure accurate and up-to-date information regarding the reimbursement of this particular CPT code.
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 26260. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action.
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
