CPT code 26525 is used to describe the surgical procedure for releasing a contracture in the finger, improving mobility and function.
CPT code 26525 is used to describe a surgical procedure that involves the release of a contracture in the finger. This procedure is typically performed to improve the function and mobility of the finger by correcting a condition where the finger is bent or unable to fully extend due to tightness in the surrounding tissues. The goal of this intervention is to restore normal movement and enhance the patient's ability to perform daily activities.
When billing for the CPT code 26525 (Release finger contracture), several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both hands or fingers.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 59 - Distinct Procedural Service
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
Applied when the same procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Used when a 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
Indicates that a procedure is unrelated to the original procedure performed during the postoperative period.
7. Modifier LT - Left Side
Used to specify that the procedure was performed on the left hand or finger.
8. Modifier RT - Right Side
Used to specify that the procedure was performed on the right hand or finger.
9. Modifier 22 - Increased Procedural Services
Indicates that the procedure was more complex than usual, warranting additional reimbursement.
10. Modifier 27 - Multiple Encounters on the Same Date
Used when a patient has multiple encounters on the same date of service.
It is essential for healthcare providers to carefully assess the specific circumstances of the procedure to determine the appropriate modifiers to use when billing for CPT code 26525. Proper use of modifiers can help ensure accurate reimbursement and compliance with payer requirements.
CPT code 26525 is reimbursed by Medicare, but the 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 their corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 26525 may also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can have localized policies that affect coverage and payment. Therefore, it is advisable to consult both the MPFS and your regional MAC to confirm the reimbursement details for CPT code 26525.
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 26525, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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
