CPT code 26262 is a medical code used to describe the procedure of resecting a tumor from the distal part of a finger.
CPT code 26262 is used to describe the surgical procedure for resecting a tumor located at the distal (farthest) part of a finger. This code is specifically utilized when a surgeon removes a tumor from the end segment of a finger, ensuring that the procedure is accurately documented for billing and insurance purposes.
When billing for CPT code 26262 (Resect distal finger tumor), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer guidelines. Below is a list of potential modifiers that could be used with CPT code 26262, 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. Documentation must support the increased complexity.
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 the procedure is one of several performed.
4. Modifier 52 (Reduced Services):
- Use this modifier if the procedure was 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):
- Apply this modifier if the same procedure was repeated by a different physician on the same day.
8. Modifier 78 (Unplanned Return to the Operating Room):
- Use this modifier if the patient required an unplanned 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):
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT (Left Side):
- Use this modifier to specify that the procedure was performed on the left hand.
11. Modifier RT (Right Side):
- Apply this modifier to specify that the procedure was performed on the right hand.
12. Modifier XS (Separate Structure):
- Use this modifier to indicate that the procedure was performed on a separate anatomical structure.
13. Modifier XE (Separate Encounter):
- Apply this modifier if the procedure was performed during a separate encounter on the same day.
14. Modifier XP (Separate Practitioner):
- Use this modifier if the procedure was performed by a different practitioner on the same day.
15. Modifier XU (Unusual Non-Overlapping Service):
- Apply this modifier to indicate that the procedure does not overlap usual components of the main service.
Proper use of these modifiers can help ensure that claims are processed correctly and that the healthcare provider receives appropriate reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific policies for the most accurate and up-to-date information.
CPT code 26262 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding reimbursement rates. However, it is essential to verify the specific details with your Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide the most accurate and up-to-date information regarding coverage and reimbursement for CPT code 26262. Each MAC may have unique guidelines and requirements that could affect the reimbursement process.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and identify underpayments down to the CPT code level, including specific codes like 26262. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and safeguard your revenue.
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
