CPT code 26755 is used to describe the treatment of a finger fracture, detailing the specific procedure performed on the injured digit.
CPT code 26755 is used to describe the treatment of a finger fracture. This code specifically refers to the procedure of managing a fracture in one of the fingers, which may involve techniques such as realignment, stabilization, or immobilization to ensure proper healing. It is typically utilized by healthcare providers when documenting the care provided to patients with this specific type of injury.
When billing for CPT code 26755, 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 should be applied when multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier is appropriate if the treatment is part of a staged procedure or if it is a subsequent procedure related to the initial treatment.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure is performed by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is relevant if the patient requires an unplanned 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 should be used if a procedure unrelated to the original procedure is performed during the postoperative period.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used if the same laboratory test is performed multiple times on the same day.
10. Modifier KX - Requirements Met: This modifier indicates that specific documentation requirements have been met for the service being billed.
Each of these modifiers serves a distinct purpose and should be used based on the specific clinical scenario to ensure accurate billing and compliance with payer requirements.
CPT code 26755 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and guidelines for services covered under Medicare Part B.
Additionally, the reimbursement for CPT code 26755 may vary depending on the local coverage determinations (LCDs) set by the Medicare Administrative Contractor (MAC) for your region. It is essential to consult the MPFS and your regional MAC to understand the exact reimbursement details and any specific requirements or limitations 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 the ability to identify discrepancies for specific codes like 26755, you can ensure that your practice is receiving the full reimbursement it deserves. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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