CPT code 26765 is used to describe the treatment of a finger fracture, detailing the specific procedure performed on the injured finger.
CPT code 26765 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 manipulation, stabilization, or other therapeutic interventions to ensure proper healing and function of the digit.
When billing for CPT code 26765, 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 (bilateral).
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 59 - Distinct Procedural Service
Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side
Indicates that the procedure was performed on the left hand.
5. Modifier RT - Right Side
Indicates that the procedure was performed on the right hand.
6. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the same procedure is repeated by the same provider on the same day.
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 on the same day.
8. Modifier 22 - Increased Procedural Services
Used when the procedure performed is more complex than usual, warranting additional reimbursement.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
Indicates that an evaluation and management service was provided during the postoperative period for a reason unrelated to the original procedure.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Used when a patient has multiple outpatient encounters on the same day.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and reimbursement in accordance with the specific circumstances surrounding the treatment of the finger fracture.
The CPT code 26765 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 and their corresponding payment rates.
Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may apply to CPT code 26765.
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