CPT code 26432 is for the surgical repair of a finger tendon, ensuring proper function and mobility of the finger.
CPT code 26433 is used for the surgical repair of a tendon in a finger. This procedure is typically necessary when a tendon in the finger has been damaged or severed due to injury or other medical conditions. The repair involves suturing the tendon back together to restore function and mobility to the finger.
When billing for CPT code 26433 (Repair finger 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 26433, along with the reasons for their use:
1. Modifier 22 - Increased Procedural Services
- Use this modifier when the work required to perform the procedure is substantially greater than typically required. Documentation must support the additional effort.
2. Modifier 50 - Bilateral Procedure
- Apply this modifier if the procedure is performed on both hands 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 done.
4. Modifier 52 - Reduced Services
- This modifier is used when the procedure is partially reduced or eliminated at the physician's discretion.
5. Modifier 59 - Distinct Procedural Service
- Use this modifier to indicate that the procedure is 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 76 - Repeat Procedure by Same Physician
- Apply this modifier if the same procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
- Use this modifier when the same procedure is repeated by a different physician on the same day.
8. 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 when the patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
10. Modifier LT - Left Side
- Apply this modifier to indicate that the procedure was performed on the left side of the body.
11. Modifier RT - Right Side
- Use this modifier to indicate that the procedure was performed on the right side of the body.
12. Modifier XS - Separate Structure
- This modifier is used to indicate that a service is distinct because it was performed on a separate organ/structure.
13. Modifier XE - Separate Encounter
- Use this modifier to indicate that a service is distinct because it was performed during a separate encounter.
14. Modifier XP - Separate Practitioner
- Apply this modifier to indicate that a service is distinct because it was performed by a different practitioner.
15. Modifier XU - Unusual Non-Overlapping Service
- Use this modifier to indicate that a service is distinct because it does not overlap usual components of the main service.
Proper use of these modifiers ensures that the billing accurately reflects the services provided and can help avoid claim denials or delays in reimbursement. Always refer to the latest coding guidelines and payer-specific policies for the most accurate and up-to-date information.
The CPT code 26433 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should refer to the MPFS, which provides detailed information on the payment policies and rates for various CPT codes. Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement for CPT code 26433.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 26433. Schedule a demo today to see how RevFind can help you ensure accurate reimbursements from every payer.
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
