CPT Code 25360

CPT code 25355 is for the surgical revision of the radius, a procedure to correct or improve a previous surgery on the forearm bone.

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What is CPT Code 25360

CPT code 25360 is a medical billing code used to describe the surgical procedure for the revision of the ulna. This involves correcting or modifying a previous surgery on the ulna, which is one of the two long bones in the forearm. This code is used by healthcare providers to ensure accurate billing and documentation for this specific type of orthopedic surgery.

Does CPT 25360 Need a Modifier?

For CPT code 25360 (Revision of ulna), the following modifiers may be applicable depending on the specific circumstances of the procedure:

1. Modifier 22 - Increased Procedural Services: Use this modifier if the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.

2. Modifier 50 - Bilateral Procedure: If the revision of the ulna is performed on both arms during the same surgical session, this modifier should be appended.

3. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier should be used to indicate that multiple services were provided.

4. Modifier 52 - Reduced Services: If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used.

5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.

6. Modifier 76 - Repeat Procedure by Same Physician: If the same physician needs to repeat the procedure on the same day, this modifier should be appended.

7. Modifier 77 - Repeat Procedure by Another Physician: If a different physician repeats the procedure on the same day, this modifier should be used.

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: Use this modifier if the patient requires a 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: If an unrelated procedure is performed by the same physician during the postoperative period, this modifier should be used.

10. Modifier 80 - Assistant Surgeon: If an assistant surgeon is required for the procedure, this modifier should be appended.

11. Modifier 81 - Minimum Assistant Surgeon: Use this modifier if a minimum assistant surgeon is required for the procedure.

12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): If an assistant surgeon is required because a qualified resident surgeon is not available, this modifier should be used.

13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Use this modifier when these non-physician practitioners assist in the surgery.

Each modifier serves a specific purpose and should be used accurately to ensure proper billing and reimbursement. Always refer to the latest CPT guidelines and payer policies for the most current information.

CPT Code 25360 Medicare Reimbursement

The CPT code 25360 is reimbursed by Medicare, but it is essential to verify the specifics 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, which are private health care insurers contracted by Medicare, can offer localized guidance and updates on coverage policies. Therefore, while CPT code 25360 is generally reimbursed, checking with the MPFS and your specific MAC will ensure accurate and up-to-date information regarding its reimbursement status.

Are You Being Underpaid for 25360 CPT Code?

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