CPT code 26352 is a medical code used to describe the procedure for repairing or grafting a tendon in the hand.
CPT code 26356 is used to describe the surgical procedure for repairing a tendon in the finger or hand. This code is specifically assigned to the medical service where a healthcare provider surgically fixes a damaged or torn tendon, which is crucial for restoring the normal function and movement of the affected finger or hand. This procedure is often necessary due to injuries or conditions that impair tendon function, and it aims to improve the patient's ability to use their hand effectively.
When billing for CPT code 26356 (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 26356, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier if the procedure required significantly greater effort or complexity than typically required.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the tendon repair was performed on both hands or fingers during the same operative session.
3. Modifier 51 - Multiple Procedures
- Use this modifier when multiple procedures, including the tendon repair, are performed during the same surgical session.
4. Modifier 52 - Reduced Services
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
5. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if the tendon repair is part of a staged or related procedure during the postoperative period of an initial surgery.
6. Modifier 59 - Distinct Procedural Service
- Apply this modifier to indicate that the tendon repair was a distinct procedural service from other services performed on the same day.
7. Modifier 62 - Two Surgeons
- Use this modifier if two surgeons were required to perform the tendon repair procedure together.
8. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
- Apply this modifier if the tendon repair procedure needed to be repeated by the same provider.
9. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
- Use this modifier if the tendon repair procedure was repeated by a different provider.
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
- Apply this modifier if the patient needed to return 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
- Use this modifier if the tendon repair is unrelated to the original procedure performed during the postoperative period.
12. Modifier 80 - Assistant Surgeon
- Apply this modifier if an assistant surgeon was necessary for the tendon repair procedure.
13. Modifier 81 - Minimum Assistant Surgeon
- Use this modifier if a minimum assistant surgeon was required for the procedure.
14. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available)
- Apply this modifier if an assistant surgeon was needed due to the unavailability of a qualified resident surgeon.
15. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
- Use this modifier if a PA, NP, or CNS assisted in the tendon repair surgery.
Correctly applying these modifiers can help ensure that claims for CPT code 26356 are processed accurately and efficiently, leading to appropriate reimbursement and compliance with payer guidelines.
The CPT code 26356 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm the reimbursement specifics, as MACs can provide localized guidance and any updates or changes to coverage policies.
Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level and by individual payer. Ensure you're receiving accurate reimbursements for procedures like CPT code 26356. Schedule a demo today to see how RevFind can optimize your revenue cycle management.
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
