CPT code 26372 is a medical code used to describe the procedure for repairing or grafting a hand tendon.
CPT code 26373 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 procedure to fix a damaged or torn tendon, which is crucial for restoring the normal function and movement of the finger or hand.
When billing for CPT code 26373 (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 modifiers that could be used with CPT code 26373, 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 procedure was performed on both hands or both sides of the body during the same 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
- Apply this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
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
- Apply this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
7. Modifier 76 - Repeat Procedure by Same Physician
- Use this modifier if the same procedure was repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
- Apply this modifier if the same procedure was repeated by a different physician on the same day.
9. 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.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Apply this modifier if an unrelated procedure was performed by the same physician during the postoperative period of the initial procedure.
11. Modifier 80 - Assistant Surgeon
- Use this modifier if an assistant surgeon was required during the procedure.
12. Modifier 81 - Minimum Assistant Surgeon
- Apply this modifier if a minimum assistant surgeon was required during the procedure.
13. 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.
14. 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.
15. Modifier LT - Left Side (used to identify procedures performed on the left side of the body)
- Apply this modifier if the procedure was performed on the left hand.
16. Modifier RT - Right Side (used to identify procedures performed on the right side of the body)
- Use this modifier if the procedure was performed on the right hand.
Proper use of these modifiers ensures that claims are processed correctly and that the healthcare provider receives appropriate reimbursement for the services rendered. Always verify payer-specific guidelines as they may have unique requirements or restrictions regarding modifier usage.
The CPT code 26373 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 corresponding payment rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have specific guidelines and policies that influence payment. Therefore, it is advisable to consult the MPFS and the relevant MAC for precise information regarding the reimbursement of CPT code 26373.
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