CPT code 26474 is a medical billing code used for the fusion of finger tendons in healthcare services.
CPT code 26474 is used to describe the surgical procedure for the fusion of finger tendons. This code indicates that a healthcare provider has performed a surgical intervention to connect or join the tendons in a finger, which may be necessary due to injury, disease, or other conditions affecting tendon function. The procedure aims to restore movement and stability to the affected finger, improving the patient's overall hand function.
When billing for the CPT code 26474, which pertains to the fusion of finger tendons, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both hands or fingers.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 59 - Distinct Procedural Service
Used to indicate that a procedure was distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
Applied when the same procedure is performed again by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Indicates that a patient returned to the operating room for a related procedure during the postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
7. Modifier LT - Left Side
Indicates that the procedure was performed on the left hand or finger.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right hand or finger.
9. Modifier 22 - Increased Procedural Services
Used when the work required to provide a service is substantially greater than typically required.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Indicates that multiple evaluation and management services were provided on the same day.
Each of these modifiers serves to provide additional context to the billing process, ensuring accurate reimbursement and compliance with payer requirements. It is essential for healthcare providers to select the appropriate modifiers based on the specific details of the procedure performed.
The CPT code 26474 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 and the corresponding payment rates. However, it is important to note that the final determination of reimbursement for CPT code 26474 may also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and may have additional local coverage determinations that affect reimbursement. Therefore, it is advisable to consult both the MPFS and your regional MAC to confirm the reimbursement status and any specific requirements for CPT code 26474.
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