CPT code 26665 is used to describe the treatment of a thumb fracture, detailing the specific procedure performed for billing and documentation.
CPT code 26665 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 the use of internal fixation devices to stabilize the bone and promote proper healing. This procedure is typically performed when the fracture is displaced or unstable, requiring surgical intervention to restore function and alignment.
When billing for CPT code 26665, 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 appropriate if 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: Use this modifier 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 or Service by Same Physician or Other Qualified Health Care Professional: This modifier is applicable if the procedure is repeated on the same day by the same provider.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by a different provider.
6. 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: This modifier is relevant if an unplanned return to the operating room is necessary for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: This modifier should be used if a procedure unrelated to the initial treatment is performed during the postoperative period.
8. Modifier 22 - Increased Procedural Services: This modifier can be used if the complexity of the procedure significantly exceeds the usual level of service.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period: This modifier is applicable if an unrelated evaluation and management service is provided during the postoperative period.
10. Modifier 27 - Multiple Encounters on the Same Date: Use this modifier if multiple encounters occur on the same date of service for different issues.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the treatment to ensure accurate billing and compliance with payer requirements.
The CPT code 26665 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT code 26665 is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database. This database provides detailed information on the payment rates for services covered by Medicare.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on whether CPT code 26665 is reimbursed and under what conditions. Providers should verify with their respective MAC to ensure compliance with local coverage determinations and any additional documentation requirements that may apply.
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 26665, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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
