CPT code 26952 is for the surgical amputation of a finger or thumb, used for billing and documentation in healthcare services.
CPT code 26952 is used to describe the surgical procedure involving the amputation of a finger or thumb. This code specifically indicates that the entire digit is removed, which may be necessary due to trauma, disease, or other medical conditions affecting the finger or thumb. It is important for healthcare providers to use this code accurately to ensure proper billing and reimbursement for the procedure performed.
When billing for CPT code 26952 (Amputation of finger/thumb), 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
- Used when the procedure is performed on both the left and right fingers or thumbs.
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 a procedure was distinct or independent from other services performed on the same day.
4. Modifier -76: Repeat Procedure by Same Physician
- Applied when the same procedure is performed more than once by the same physician on the same day.
5. Modifier -78: Unplanned Return to the Operating/Procedure Room
- Indicates that a patient returned to the operating room for a related procedure within the global period.
6. Modifier -79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
7. Modifier -RT: Right Side
- Indicates that the procedure was performed on the right side of the body.
8. Modifier -LT: Left Side
- Indicates that the procedure was performed on the left side of the body.
9. Modifier -E1: Upper Left Eyelid
- Used if the amputation involves the upper left eyelid (specific to eyelid procedures).
10. Modifier -E2: Upper Right Eyelid
- Used if the amputation involves the upper right eyelid (specific to eyelid procedures).
11. Modifier -E3: Lower Left Eyelid
- Used if the amputation involves the lower left eyelid (specific to eyelid procedures).
12. Modifier -E4: Lower Right Eyelid
- Used if the amputation involves the lower right eyelid (specific to eyelid procedures).
It is essential to select the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 26952 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to ensure that there are no regional variations or specific documentation requirements that could affect reimbursement. Each MAC may have unique guidelines or policies that influence how CPT code 26952 is processed and reimbursed.
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