CPT code 26645 is used to describe the treatment of a thumb fracture, detailing the specific procedure performed by healthcare providers.
CPT code 26645 is used to describe the surgical treatment of a thumb fracture. This code specifically refers to the procedure involving the internal fixation of a fracture in the thumb, which may include the use of pins, screws, or plates to stabilize the bone and promote proper healing. It is typically utilized when conservative treatment methods, such as splinting or casting, are insufficient for ensuring optimal recovery of the thumb's function and structure.
When billing for CPT code 26645, which pertains to the treatment of a thumb fracture, 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 thumbs.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if the procedure is performed alongside other surgical procedures during the same session.
3. Modifier 58 - Staged or Related Procedure or Service: This modifier should be used if the treatment is part of a staged procedure or if it is a subsequent procedure related to the initial treatment.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires an unplanned return to the operating room for complications related to the initial procedure.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if a different procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right thumb.
8. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left thumb.
9. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is applicable if the patient has multiple encounters on the same day for different services.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 26645 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 specific guidelines and fee schedules that apply to their jurisdictions. Therefore, it is advisable to consult the MPFS and the relevant MAC for precise information on the reimbursement rate and any specific billing requirements for CPT code 26645.
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