CPT code 26372 is for the repair or grafting of a hand tendon, a procedure to restore function and mobility to the hand.
CPT code 26372 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 mending or replacing a damaged tendon in the hand, ensuring proper function and mobility.
For CPT code 26372 (Repair/graft hand tendon), the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: Used when the work required to perform the procedure is substantially greater than typically required.
2. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both hands during the same session.
3. Modifier 51 - Multiple Procedures: Used when multiple procedures are performed during the same surgical session.
4. Modifier 52 - Reduced Services: Used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 53 - Discontinued Procedure: Used when the procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
6. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
7. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.
8. Modifier 66 - Surgical Team: Used when a team of surgeons is required to perform the procedure.
9. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs a procedure or service again on the same day.
10. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician 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: Used when a related procedure is performed during the postoperative period of the initial procedure.
12. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used when an unrelated procedure is performed by the same physician during the postoperative period.
13. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required for the procedure.
14. Modifier 81 - Minimum Assistant Surgeon: Used when a minimum assistant surgeon is required for the procedure.
15. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is required and a qualified resident surgeon is not available.
16. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.
Each of these modifiers serves a specific purpose and should be used accurately to ensure proper billing and reimbursement for the services provided.
CPT code 26372 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, along with the corresponding reimbursement rates. To determine the exact reimbursement for CPT code 26372, healthcare providers should consult the MPFS for the current year.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and ensuring compliance with Medicare policies. They may have specific local coverage determinations (LCDs) that affect the reimbursement of CPT code 26372. Therefore, it is essential for healthcare providers to verify the coverage and reimbursement details with their respective MAC to ensure accurate billing and payment.
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