CPT code 26357 is a medical code used to describe the surgical repair of a tendon in the finger or hand.
CPT code 26358 is used to describe the surgical procedure for repairing or grafting a tendon in the hand. This code is utilized by healthcare providers to document and bill for the specific service of fixing a damaged tendon or using a graft to replace or support the tendon in the hand. This procedure is often necessary to restore function and mobility to the hand after an injury or due to a medical condition affecting the tendons.
When billing for CPT code 26358 (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 potential modifiers that could be used with CPT code 26358, 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. This could be due to factors such as increased complexity, time, or effort.
2. Modifier 50 (Bilateral Procedure)
- Apply this modifier if the procedure was performed on both hands during the same surgical session.
3. Modifier 51 (Multiple Procedures)
- Use this modifier when multiple procedures are performed during the same surgical session. This helps indicate that more than one procedure was carried out.
4. Modifier 52 (Reduced Services)
- This modifier is used 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. This is often used to bypass National Correct Coding Initiative (NCCI) edits.
6. Modifier 62 (Two Surgeons)
- Use this modifier if two surgeons worked together as primary surgeons, each performing distinct parts of the procedure.
7. Modifier 66 (Surgical Team)
- This modifier is used when a complex procedure requires the expertise of a surgical team.
8. Modifier 76 (Repeat Procedure by Same Physician)
- Apply this modifier if the same physician repeats the procedure on the same day.
9. Modifier 77 (Repeat Procedure by Another Physician)
- Use 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)
- This modifier is used if the patient needs 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)
- Apply this modifier if 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 if an assistant surgeon was required to help with the procedure.
13. Modifier 81 (Minimum Assistant Surgeon)
- This modifier is used 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 necessary because a qualified resident surgeon was not available.
15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery)
- Use this modifier if a non-physician provider assisted in the surgery.
Correctly applying these modifiers can help ensure that claims are processed accurately and that healthcare providers receive appropriate reimbursement for their services. Always refer to the latest coding guidelines and payer-specific requirements when using modifiers.
The CPT code 26358 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to confirm the specific reimbursement rate. Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) for your region. Each MAC may have different guidelines and coverage determinations, so it is advisable to consult the local MAC's policies to ensure accurate billing and reimbursement for CPT code 26358.
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