CPT code 26560 is for the surgical repair of a webbed finger, detailing the specific procedure for billing and documentation purposes.
CPT code 26560 is used to describe the surgical procedure for the repair of a webbed finger, a condition where two or more fingers are fused together by skin or tissue. This code specifically indicates that the procedure involves reconstructing the normal separation between the fingers to improve function and appearance.
When billing for the CPT code 26560 (Repair of web finger), 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 or fingers.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if the repair of the web finger is performed alongside other surgical procedures during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed separately from other procedures that may be related or bundled.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated on the same finger or hand by the same physician on the same day.
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 complications related to the initial procedure.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier should be used if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
7. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right hand or finger.
8. Modifier LT - Left Side: This modifier is used if the procedure is performed on the left hand or finger.
9. Modifier E1 - Upper Left Eyelid: If the procedure involves the upper left eyelid, this modifier is applicable.
10. Modifier E2 - Upper Right Eyelid: Use this modifier for procedures involving the upper right eyelid.
11. Modifier E3 - Lower Left Eyelid: This modifier is relevant for procedures involving the lower left eyelid.
12. Modifier E4 - Lower Right Eyelid: Use this modifier for procedures involving the lower right eyelid.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 26560 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 additional requirements, healthcare providers should consult the MPFS, which provides detailed information on payment rates and guidelines for various CPT codes.
Additionally, it is essential to verify with the local Medicare Administrative Contractor (MAC) for any region-specific policies or additional documentation requirements that may affect reimbursement for CPT code 26560.
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