CPT code 26412 is for the repair or grafting of a hand tendon, a procedure to restore function and mobility in the hand.
CPT code 26412 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 be repaired.
For CPT code 26412 (Repair/graft hand tendon), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. This could be due to factors such as the complexity of the patient's condition or the extent of the repair needed.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed on the same day.
3. Modifier 59 - Distinct Procedural Service: Apply this modifier to indicate that the procedure is distinct or independent from other services performed on the same day. This is particularly useful if the repair/graft is performed on a different tendon or in a different anatomical site.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure is repeated by the same physician on the same day. This could occur if additional repair is needed due to unforeseen complications.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is repeated by a different physician on the same day.
6. 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 applicable if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if the procedure is performed during the postoperative period of another procedure but is unrelated to the initial surgery.
8. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left hand.
9. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right hand.
10. Modifier XS - Separate Structure: This modifier indicates that a service is distinct because it was performed on a separate organ/structure.
11. Modifier XE - Separate Encounter: Use this modifier to indicate that the procedure was performed during a separate encounter on the same day.
12. Modifier XP - Separate Practitioner: This modifier is used when the procedure is performed by a different practitioner.
13. Modifier XU - Unusual Non-Overlapping Service: Apply this modifier to indicate that the service does not overlap usual components of the main service.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Determining whether CPT code 26412 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by your regional Medicare Administrative Contractor (MAC). The MPFS is a comprehensive listing of the payment rates used by Medicare to reimburse physicians and other healthcare providers. To verify if CPT code 26412 is reimbursed, you would need to check the MPFS for the specific payment rate and any associated guidelines or restrictions.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing Medicare claims and providing coverage decisions. Each MAC may have specific local coverage determinations (LCDs) that can affect whether a particular CPT code, such as 26412, is reimbursed in your region. Therefore, it is essential to review both the MPFS and any relevant LCDs from your MAC to confirm the reimbursement status of CPT code 26412.
In summary, to determine if CPT code 26412 is reimbursed by Medicare, you should consult the Medicare Physician Fee Schedule and the local coverage determinations provided by your Medicare Administrative Contractor.
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