CPT code 26650 is used to describe the treatment of a thumb fracture, detailing the specific procedure performed for billing and documentation.
CPT code 26650 is used to describe the surgical procedure for treating a fracture of the thumb. This code specifically refers to the open treatment of a fracture in the thumb's metacarpal bone, which may involve realigning the bone fragments and securing them with hardware, such as pins or screws, to ensure proper healing and restore function.
When billing for the CPT code 26650, which pertains to the treatment of a thumb fracture, the following modifiers may be applicable:
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 multiple procedures are performed during the same session, indicating that the primary procedure is being billed along with additional procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used when the procedure is performed separately from other procedures on the same day, indicating that it is not part of a bundled service.
4. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left thumb.
5. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right thumb.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the procedure is repeated by the same physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient requires a return to the operating room for a related procedure within the global period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if a different procedure is performed by the same physician during the postoperative period of the original procedure.
9. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is relevant if an evaluation and management service is provided during the postoperative period that is unrelated to the original procedure.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 26650 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their corresponding reimbursement rates. Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations (LCDs) or specific billing guidelines that may apply to CPT code 26650. Each MAC may have unique requirements or documentation standards that must be met to ensure proper reimbursement.
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 and by individual payer. With RevFind, you can identify discrepancies for specific codes like 26650, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can streamline your processes and improve your bottom line.
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
