CPT code 26341 is for the manipulation of a palm cord after an injection, typically used in treating conditions like Dupuytren's contracture.
CPT code 26350 is used to describe the surgical procedure for repairing a tendon in the finger or hand. This code is specifically utilized when a healthcare provider performs a surgical intervention to fix a damaged or torn tendon, which is crucial for restoring the normal function and movement of the affected finger or hand. The procedure may involve suturing the tendon back together or using other techniques to ensure proper healing and functionality.
When billing for CPT code 26350 (Repair finger/hand tendon), 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 26350, 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
- Use this modifier if the procedure was performed on both hands or both sides of the body during the same session.
3. Modifier 51 - Multiple Procedures
- Use this modifier if multiple procedures were performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 52 - Reduced Services
- Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion. Documentation should support the reason for the reduction.
5. Modifier 53 - Discontinued Procedure
- Use this modifier if the procedure was started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
7. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons worked together as primary surgeons performing distinct parts of the procedure.
8. Modifier 66 - Surgical Team
- Use this modifier if the procedure required the services of a surgical team due to its complexity.
9. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician performed the procedure more than once on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier if a different physician performed the procedure 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 had to 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
- Use this modifier if the procedure was unrelated to the original procedure and was performed during the postoperative period.
13. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required to help with the procedure.
14. Modifier 81 - Minimum Assistant Surgeon
- Use 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 required because a qualified resident surgeon was not available.
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.
Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Proper documentation is crucial to support the use of these modifiers.
CPT code 26350 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective payment rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement rate and any specific billing requirements for CPT code 26350.
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