CPT Code 25312

CPT code 25312 is a medical code used to describe the procedure for transplanting a tendon in the forearm.

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What is CPT Code 25312

CPT code 25312 is used to describe the surgical procedure for transplanting a tendon in the forearm. This code is specifically utilized when a tendon from another part of the body is moved to the forearm to restore function or repair damage. This procedure is often necessary for patients who have experienced tendon injuries or degenerative conditions that impair movement and strength in the forearm.

Does CPT 25312 Need a Modifier?

When billing for CPT code 25312 (Transplant forearm tendon), it is essential to consider the appropriate use of modifiers to ensure accurate reimbursement and compliance with payer requirements. Below is a list of potential modifiers that could be used with CPT code 25312, along with the reasons for their use:

1. Modifier 22 (Increased Procedural Services): Used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the increased complexity.

2. Modifier 50 (Bilateral Procedure): Applied if the tendon transplant is performed on both forearms during the same operative session.

3. Modifier 51 (Multiple Procedures): Used when multiple procedures, other than E/M services, are performed at the same session by the same provider.

4. Modifier 52 (Reduced Services): Indicates that the service provided was less than usually required. This might be used if the procedure was partially completed due to unforeseen circumstances.

5. Modifier 59 (Distinct Procedural Service): Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This is often used to bypass National Correct Coding Initiative (NCCI) edits.

6. Modifier 76 (Repeat Procedure by Same Physician): Applied if the same procedure is repeated by the same physician on the same day.

7. Modifier 77 (Repeat Procedure by Another Physician): Used if the same procedure is repeated by a different physician on the same day.

8. Modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period): Indicates an unplanned return to the operating room for a related procedure during the postoperative period.

9. Modifier 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period): Used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

10. Modifier LT (Left Side): Indicates that the procedure was performed on the left forearm.

11. Modifier RT (Right Side): Indicates that the procedure was performed on the right forearm.

12. Modifier 62 (Two Surgeons): Used when two surgeons work together as primary surgeons performing distinct parts of a single reportable procedure.

13. Modifier 66 (Surgical Team): Applied when a team of surgeons is required to perform the procedure.

14. Modifier 80 (Assistant Surgeon): Used when an assistant surgeon is required during the procedure.

15. Modifier 81 (Minimum Assistant Surgeon): Indicates that a minimum assistant surgeon was required.

16. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary, and a qualified resident surgeon is not available.

17. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): Indicates that a non-physician provider assisted in the surgery.

Proper use of these modifiers ensures that claims are processed correctly and that the healthcare provider receives appropriate reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific policies for accurate modifier application.

CPT Code 25312 Medicare Reimbursement

The CPT code 25312 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs may have specific guidelines or requirements for reimbursement, so it is crucial to consult with your local MAC to ensure compliance and accurate billing.

Are You Being Underpaid for 25312 CPT Code?

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