CPT code 26479 is used to describe the surgical procedure for shortening a tendon in the hand.
CPT code 26479 is used to describe the surgical procedure for shortening a tendon in the hand. This procedure typically involves the removal of a portion of the tendon to alleviate tension or improve function, often in cases where the tendon is causing pain or limiting movement. It is commonly performed to address conditions such as tendon injuries or deformities in the hand.
When billing for the CPT code 26479, which pertains to the shortening of hand 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.
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 distinct or independent 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 postoperative 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.
7. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left hand.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right hand.
9. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier is used when the service is performed by a non-physician practitioner.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than usual.
It is essential to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 26479 is reimbursed by Medicare, but its 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. To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidelines and policies that may affect the reimbursement of CPT code 26479. It is advisable for healthcare providers to check with their respective MAC to ensure compliance with local coverage determinations and any other pertinent regulations.
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 RevFind, you can identify discrepancies for specific codes like 26479, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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