CPT code 26455 is for the surgical incision of a finger tendon, used to describe a specific medical procedure in billing and documentation.
CPT code 26455 is for the surgical procedure involving the incision of a finger tendon. This code is used when a healthcare provider performs an operation to access and treat a tendon in the finger, typically to repair a tendon injury or to relieve a condition affecting the tendon. This procedure may be necessary for restoring function or alleviating pain in the affected finger.
When billing for the CPT code 26455 (Incision of finger tendon), several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both hands or fingers.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used to indicate that the procedure is separate and distinct from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if a different procedure is performed by the same physician during the postoperative period of the original procedure.
7. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right hand or finger.
8. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left hand or finger.
9. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is applicable when the patient has multiple encounters on the same day for different services.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 26455 is reimbursed by Medicare. The reimbursement is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for various services.
Additionally, the specific reimbursement amount may vary depending on the Medicare Administrative Contractor (MAC) responsible for processing claims in your region.
It is advisable for healthcare providers to verify the reimbursement status and rates with their respective MAC to ensure accurate billing and payment.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. With the ability to identify discrepancies for specific codes like 26455, you can ensure that your practice is receiving the full reimbursement it deserves. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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
