CPT code 26742 is used to describe the treatment of a finger fracture, detailing the specific procedure performed for each finger.
CPT code 26742 is used to describe the treatment of a finger fracture, specifically indicating that the procedure involves the management of each individual finger fracture. This code is typically utilized when a healthcare provider performs a procedure to stabilize or repair a fractured finger, ensuring proper healing and function.
When billing for CPT code 26742, which pertains to the treatment of a finger 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 hands or fingers.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if the treatment of the finger fracture is performed alongside other procedures during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used when the procedure is distinct or independent from other services performed on the same day.
4. Modifier RT - Right Side: Use this modifier to indicate that the procedure was performed on the right hand or finger.
5. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left hand or finger.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician on the same day.
8. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
9. 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.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is used when a patient has multiple encounters on the same date of service.
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 26742 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 respective payment rates. Additionally, it is crucial to consult your regional Medicare Administrative Contractor (MAC) for any local coverage determinations (LCDs) or specific billing guidelines that may affect reimbursement for CPT code 26742. Each MAC may have unique policies that influence how this code is processed and reimbursed.
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