CPT code 26485 is used to describe the surgical procedure for transplanting a palm tendon in the hand.
CPT code 26485 is used to describe the surgical procedure of transplanting a tendon from the palm. This procedure typically involves relocating a tendon to restore function or improve movement in the hand or fingers, often due to injury or a condition that affects the tendons. It is a specialized intervention aimed at enhancing the patient's ability to perform daily activities by improving hand function.
When billing for the CPT code 26485, which pertains to the transplantation of a palm 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 applicable if 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: Use this modifier if the procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is appropriate 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 LT - Left Side: Use this modifier to specify that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right 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.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: This modifier is applicable if the patient has multiple evaluation and management encounters on the same day.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
Determining if CPT code 26485 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 covered by Medicare and their corresponding reimbursement rates. To verify if CPT code 26485 is reimbursed, you would need to check the MPFS for the specific year in question.
Additionally, your regional MAC may have specific guidelines or coverage determinations that could affect reimbursement. Therefore, it is essential to review both the MPFS and any relevant local coverage determinations (LCDs) issued by your MAC to confirm if CPT code 26485 is reimbursed by Medicare.
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. For instance, with CPT code 26485, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
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