CPT code 26498 is a medical billing code used for finger tendon transfer procedures in healthcare.
CPT code 26498 is used to describe a surgical procedure involving the transfer of a tendon in the finger. This procedure is typically performed to restore function or movement in the finger after an injury or condition that has compromised the tendon. The transfer involves relocating a tendon from one area to another to improve the patient's ability to grasp or manipulate objects.
When billing for CPT code 26498 (Finger tendon transfer), 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 tendon transfer is performed on both hands.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if multiple procedures are performed during the same session, including the tendon transfer.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used if the tendon transfer is performed separately from other procedures that may be billed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: If the tendon transfer is performed more than once by the same physician on the same day, this modifier should be applied.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable 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: Use this modifier if a different procedure is performed by the same physician during the postoperative period of the tendon transfer.
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 22 - Increased Procedural Services: If the procedure required significantly more work than typically required, this modifier can be used to indicate the increased complexity.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is used when a patient has multiple encounters on the same day, which may include the tendon transfer.
It is essential to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 26498 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 26498.
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