CPT code 26260 is a medical code used to describe the surgical procedure for resecting a tumor in the proximal finger.
CPT code 26261 is used to describe an extensive surgical procedure on the finger. This code is typically utilized when a surgeon performs a complex operation that involves significant work on the finger's structures, such as tendons, joints, or bones. The procedure may be necessary to address severe injuries, deformities, or conditions that impair the finger's function. By using this specific CPT code, healthcare providers can accurately document and bill for the intricate nature of the surgery performed.
For CPT code 26261, which pertains to extensive finger surgery, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could apply if the surgery was more complex or time-consuming than usual.
2. Modifier 50 - Bilateral Procedure: Used if the surgery was performed on both hands during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session. This is common in extensive surgeries where additional procedures are necessary.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when the procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
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 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team: Used when a highly complex procedure requires the services of several physicians, often of different specialties, plus other highly skilled personnel.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same procedure is repeated by the same physician.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when the same procedure is repeated by a different physician.
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: Used when a patient requires a 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: Used when a procedure or service performed during the postoperative period is unrelated to the original procedure.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required during the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the extensive finger surgery procedure.
The reimbursement of CPT code 26261 by Medicare depends on its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for your region. To determine if CPT code 26261 is reimbursed, healthcare providers should consult the MPFS, which outlines the payment rates for services covered by Medicare. Additionally, it is crucial to review the local coverage determinations (LCDs) and national coverage determinations (NCDs) provided by the MAC, as these documents offer detailed information on the coverage criteria and any potential restrictions. By cross-referencing these resources, providers can ascertain whether CPT code 26261 is eligible for reimbursement under Medicare.
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