CPT code 26480 is a medical billing code used for the surgical procedure of transplanting a tendon in the hand.
CPT code 26480 is used to describe the surgical procedure for transplanting a tendon in the hand. This code specifically refers to the transfer of a tendon from one location to another within the hand to restore function or improve movement. It is typically utilized in cases where there is damage or dysfunction in the hand's tendons, allowing for enhanced rehabilitation and recovery of hand function.
When billing for the CPT code 26480, which pertains to the transplantation of hand tendons, there are several modifiers that 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: This modifier is used when the procedure is performed on both hands or both sides of the body.
2. Modifier 51 - Multiple Procedures: This modifier indicates that multiple procedures were performed during the same session. It is used to signify that the primary procedure is being billed along with additional procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure was distinct or independent from other services performed on the same day. It is applicable when the tendon transplant is performed in a different anatomical site or for a different reason than other procedures.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is performed more than once by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable if a patient requires a return to the operating room for a related procedure within the global period of the original procedure.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a different procedure is performed by the same physician during the postoperative period of the original procedure.
7. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right side of the body.
8. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left side of the body.
9. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is used when a patient has multiple encounters on the same date of service, which may include different procedures or services.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
Determining if CPT code 26480 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services and their corresponding reimbursement rates under Medicare Part B. To verify if CPT code 26480 is reimbursed, you would need to look up this specific code in the MPFS database.
Additionally, your regional MAC may have specific guidelines or coverage determinations that could affect reimbursement. It is essential to review both the MPFS and any local coverage determinations (LCDs) issued by your MAC to confirm if CPT code 26480 is eligible for Medicare reimbursement.
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 26480, 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 processes and improve your bottom line.
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
