CPT code 26490 is for the surgical procedure to revise a tendon in the thumb, ensuring proper function and movement.
CPT code 26490 is used to describe a surgical procedure that involves the revision of a tendon in the thumb. This procedure typically aims to correct issues such as tendon damage or dysfunction, ensuring proper thumb movement and function. It is often performed to address complications from previous surgeries or injuries that have affected the thumb's tendons.
When billing for the CPT code 26490 (Revise thumb 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 thumbs.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if the procedure is performed in conjunction with other surgical procedures on the same day.
3. Modifier 58 - Staged or Related Procedure: This modifier is appropriate if the revision is part of a staged procedure or if it is a subsequent procedure related to a previous surgery.
4. Modifier 78 - Unplanned Return to the Operating Room: Use this modifier if the patient requires an unplanned return to the operating room for a related procedure within the global period.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is applicable if a different procedure is performed by the same physician during the global period that is unrelated to the original procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the procedure is repeated by the same physician on the same day.
7. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
8. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is relevant if an unrelated E/M service is provided during the global period.
9. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is distinct or independent from other services performed on the same day.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier may be used if laboratory tests are repeated on the same day for the same patient.
It is essential to select the appropriate modifier based on the specific clinical scenario to ensure accurate billing and compliance with payer requirements.
The CPT code 26490 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any potential coverage limitations, healthcare providers should consult the MPFS.
Additionally, it is essential to verify with the respective Medicare Administrative Contractor (MAC) for any regional variations or additional guidelines that may apply to the reimbursement of CPT code 26490.
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