CPT code 26565 is a medical billing code used to describe the correction of a metacarpal flaw in the hand.
CPT code 26565 is used to describe a surgical procedure that corrects a flaw in the metacarpal bone of the hand. This code specifically refers to the surgical intervention aimed at addressing deformities or abnormalities in the metacarpal, which can affect hand function and overall dexterity. The procedure may involve realigning the bone or repairing any associated soft tissue to restore proper anatomy and function.
When billing for CPT code 26565, which pertains to the correction of a metacarpal flaw, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both hands.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional: This modifier is appropriate if the procedure is a staged procedure or if it is related to a previous procedure performed by the same provider.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if a return to the operating room is necessary due to complications or related issues arising from the initial procedure.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: This modifier is applicable if a completely unrelated procedure is performed during the postoperative period of the initial procedure.
6. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
7. Modifier 26 - Professional Component: If the procedure has both a professional and technical component, this modifier should be used to indicate that only the professional component is being billed.
8. Modifier TC - Technical Component: Similar to Modifier 26, this modifier indicates that only the technical component of the procedure is being billed.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used if the procedure is repeated on the same day for the same patient.
It is essential to review the specific circumstances of the procedure and the payer's guidelines to determine the appropriate modifiers to use for accurate billing and reimbursement.
The CPT code 26565 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 payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement rate and any specific billing requirements for CPT code 26565.
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