CPT Code 25492

CPT code 25492 is for a surgical procedure to reinforce the radius and ulna, typically involving the use of hardware to stabilize the bones.

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What is CPT Code 25492

CPT code 25492 is used to describe the surgical procedure for reinforcing the radius and ulna, which are the two long bones in the forearm. This code is typically used when a surgeon needs to strengthen these bones, often due to fractures, deformities, or other conditions that compromise their stability. The reinforcement may involve the use of hardware such as plates, screws, or rods to ensure proper alignment and healing.

Does CPT 25492 Need a Modifier?

When using CPT code 25492 for reinforcing the radius and ulna, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers and 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. This could be due to complications or additional work involved in reinforcing both the radius and ulna.

2. Modifier 50 (Bilateral Procedure): If the procedure is performed on both arms during the same surgical session, this modifier indicates that the procedure was bilateral.

3. Modifier 51 (Multiple Procedures): Applied when multiple procedures are performed during the same surgical session. This modifier helps in identifying that more than one procedure was carried out.

4. Modifier 52 (Reduced Services): Used when the procedure is partially reduced or eliminated at the physician's discretion. This could be relevant if only part of the reinforcement was necessary.

5. Modifier 59 (Distinct Procedural Service): Indicates that a procedure or service was distinct or independent from other services performed on the same day. This might be necessary if the reinforcement of the radius and ulna is performed in conjunction with other unrelated procedures.

6. Modifier 76 (Repeat Procedure by Same Physician): Used if the same procedure is repeated by the same physician. This could be relevant if the reinforcement needs to be done again due to complications or failure of the initial procedure.

7. Modifier 77 (Repeat Procedure by Another Physician): Similar to Modifier 76, but used when the repeat procedure is performed by a different physician.

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): This modifier is used if the patient needs to 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): Applied 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 side of the body.

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

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

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

14. Modifier 82 (Assistant Surgeon (when qualified resident surgeon not available)): Used when an assistant surgeon is necessary due to the unavailability of a qualified resident surgeon.

15. Modifier AS (Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery): Applied when these healthcare professionals assist in the surgery.

Each of these modifiers serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement. Always refer to the latest CPT coding guidelines and payer-specific requirements when applying modifiers.

CPT Code 25492 Medicare Reimbursement

CPT code 25492 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 25492. It is essential for healthcare providers to consult both the MPFS and their respective MAC to ensure compliance with Medicare's reimbursement criteria for this specific code.

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