CPT code 26615 is used to describe the treatment of a metacarpal fracture, specifically for surgical procedures on the hand.
CPT code 26615 is used to describe the surgical treatment of a metacarpal fracture, which is a break in one of the long bones in the hand that connects the wrist to the fingers. This code specifically indicates that the procedure involves the manipulation and stabilization of the fractured bone, often through internal fixation methods, to ensure proper healing and restore function to the hand.
When billing for CPT code 26615, 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 the procedure is part of a staged treatment plan or if a subsequent procedure is performed during the postoperative period.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Applied when the same procedure is 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
Indicates an unplanned return to the operating room for a related procedure.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
7. Modifier 22 - Increased Procedural Services
Indicates that the service provided was significantly greater than what is typically required for the procedure.
8. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
Used when an evaluation and management service is provided that is unrelated to the original procedure during the postoperative period.
9. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Indicates that multiple evaluation and management services were provided on the same day.
10. Modifier 59 - Distinct Procedural Service
Used to indicate that a procedure is distinct or independent from other services performed on the same day.
It is essential to select the appropriate modifier(s) based on the specific circumstances surrounding the treatment of the metacarpal fracture to ensure accurate billing and compliance with payer requirements.
The CPT code 26615 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 respective 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 details for CPT code 26615.
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