CPT code 26607 is used to describe the treatment of a metacarpal fracture, specifically for surgical procedures on the hand.
CPT code 26607 is used to describe the surgical treatment of a metacarpal fracture, specifically involving the fixation of a fracture in the bones of the hand that connect the wrist to the fingers. This code indicates that the procedure involves the stabilization of the fractured metacarpal bone, which may include the use of hardware such as pins, plates, or screws to ensure proper alignment and healing.
When billing for CPT code 26607, which pertains to the treatment of a metacarpal fracture, several modifiers may be applicable depending on the specific circumstances of the procedure. Below 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.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
Used when a subsequent procedure is planned or anticipated during the postoperative period.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Indicates that the same procedure was performed again on the same day.
5. 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
Used when a patient requires an unplanned procedure related to the original surgery.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Indicates that a procedure unrelated to the original procedure was performed during the postoperative period.
7. Modifier 22 - Increased Procedural Services
Used when the service provided is significantly greater than what is typically required for the procedure.
8. Modifier 26 - Professional Component
Indicates that only the professional component of a service is being billed.
9. Modifier TC - Technical Component
Used when only the technical component of a service is being billed.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
Indicates that a laboratory test was repeated on the same day.
These modifiers help provide additional context for the services rendered and ensure accurate billing and reimbursement for the healthcare provider. It is essential to select the appropriate modifier based on the specific circumstances of the treatment provided.
The CPT code 26607 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 26607.
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, including specific codes like 26607. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your reimbursement process. Don't leave money on the table—take the first step towards improved financial performance.
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
