CPT code 26735 is used to describe the treatment of a finger fracture, detailing the specific procedure performed on the injured finger.
CPT code 26735 is used to describe the treatment of a finger fracture. This code specifically refers to the procedure involved in managing a fracture in one of the fingers, which may include realigning the bone and stabilizing it to promote proper healing. It is typically utilized by healthcare providers when billing for the services rendered in treating this type of injury.
When billing for CPT code 26735, which pertains to the treatment of a finger 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 with this code, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both hands.
2. Modifier LT - Left Side
Indicates that the procedure was performed on the left hand.
3. Modifier RT - Right Side
Indicates that the procedure was performed on the right hand.
4. Modifier 22 - Increased Procedural Services
Used when the procedure required significantly more work than typically required.
5. Modifier 59 - Distinct Procedural Service
Indicates that the procedure is distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the same procedure is performed again by the same provider.
7. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
Indicates that the same procedure was performed by a different provider.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
Used when the same test is performed multiple times on the same day.
9. Modifier 52 - Reduced Services
Indicates that the service provided was less than the full procedure.
10. Modifier 53 - Discontinued Procedure
Used when a procedure is terminated due to extenuating circumstances.
It is essential for healthcare providers to select the appropriate modifier(s) based on the specific details of the procedure performed to ensure accurate billing and compliance with payer requirements.
The CPT code 26735 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 crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific billing requirements that may apply to CPT code 26735. Each MAC may have unique guidelines and policies that could impact the reimbursement process.
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. For instance, with CPT code 26735, RevFind can pinpoint discrepancies that may be impacting your bottom line. Schedule a demo today to see how our solution can help you recover lost revenue and ensure you are being reimbursed correctly.
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