CPT code 26352 is a medical code used to describe the procedure for repairing or grafting a tendon in the hand.
CPT code 26352 is used to describe the surgical procedure for repairing or grafting a tendon in the hand. This code is specifically utilized when a healthcare provider performs a surgical intervention to fix or replace a damaged tendon in the hand, which is crucial for restoring function and mobility. This procedure may involve suturing the tendon back together or using a graft to replace a section of the tendon that is too damaged to repair directly.
When billing for CPT code 26352 (Repair/graft 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 modifiers that could be used with CPT code 26352, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the additional effort.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure is performed on both hands during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, other than E/M services, are performed by the same provider during the same session.
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 a procedure or service was distinct or independent from other services performed on the same day.
6. Modifier 62 - Two Surgeons
- Use this modifier when two surgeons work together as primary surgeons performing distinct parts of the procedure.
7. Modifier 66 - Surgical Team
- Apply this modifier when a team of surgeons is required to perform the procedure.
8. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same physician repeats the procedure on the same day.
9. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if a different physician repeats the procedure on the same day.
10. 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 when the patient returns to the operating room for a related procedure during the postoperative period.
11. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
12. Modifier 80 - Assistant Surgeon
- Use this modifier when an assistant surgeon is required for the procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier when a minimum assistant surgeon is required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Use this modifier when an assistant surgeon is required, and a qualified resident surgeon is not available.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Apply this modifier when a non-physician provider assists in the surgery.
16. Modifier LT - Left Side
- Use this modifier to indicate that the procedure was performed on the left hand.
17. Modifier RT - Right Side
- Apply this modifier to indicate that the procedure was performed on the right hand.
Each modifier has specific documentation requirements and payer guidelines, so it is crucial to ensure that the medical records accurately reflect the circumstances necessitating the use of these modifiers. Proper use of modifiers can significantly impact the reimbursement process and compliance with coding standards.
CPT code 26352 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the allowable payment amounts for services rendered by physicians and other healthcare providers. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement eligibility for CPT code 26352. MACs are responsible for processing Medicare claims and can provide region-specific guidance on coverage and payment policies. Therefore, it is essential to consult both the MPFS and your local MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 26352.
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