CPT Code 26034

CPT code 26034 is a medical code used to describe the procedure for treating a lesion in the hand bone.

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What is CPT Code 26034

CPT code 26034 is used to describe a surgical procedure for treating a lesion in the bones of the hand. This code is specifically utilized when a healthcare provider performs an operation to remove or repair abnormal tissue or growths within the hand bones. This procedure is often necessary to alleviate pain, restore function, or prevent further complications associated with the lesion.

Does CPT 26034 Need a Modifier?

When billing for CPT code 26034 (Treat hand bone lesion), it is important 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 26034, along with the reasons for their use:

1. Modifier 22 (Increased Procedural Services): Use this modifier if the procedure required significantly more work than typically required. Documentation must support the increased complexity.

2. Modifier 50 (Bilateral Procedure): If the procedure was performed on both hands, this modifier indicates that the same procedure was performed bilaterally.

3. Modifier 51 (Multiple Procedures): Use this modifier when multiple procedures are performed during the same surgical session. It indicates that more than one procedure was performed.

4. Modifier 52 (Reduced Services): If the procedure was partially reduced or eliminated at the physician's discretion, this modifier should be used to indicate that the service provided was less than usually required.

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

6. Modifier 76 (Repeat Procedure by Same Physician): If the same procedure is repeated by the same physician on the same day, this modifier should be used.

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

8. Modifier 78 (Unplanned Return to the Operating/Procedure Room): If the patient returns to the operating room for a related procedure during the postoperative period, this modifier should be used.

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

10. Modifier LT (Left Side): Use this modifier to indicate that the procedure was performed on the left hand.

11. Modifier RT (Right Side): Use this modifier to indicate that the procedure was performed on the right hand.

12. Modifier XS (Separate Structure): This modifier indicates that a service was performed on a separate organ/structure, which may be necessary for certain payer requirements.

13. Modifier XE (Separate Encounter): Use this modifier to indicate that the procedure was performed during a separate encounter on the same day.

14. Modifier XP (Separate Practitioner): This modifier is used when a procedure is performed by a different practitioner on the same day.

15. Modifier XU (Unusual Non-Overlapping Service): This modifier indicates that the service does not overlap usual components of the main service.

Proper use of these modifiers can help ensure that claims are processed correctly and that healthcare providers receive appropriate reimbursement for the services rendered. Always refer to the latest coding guidelines and payer-specific requirements when applying modifiers.

CPT Code 26034 Medicare Reimbursement

CPT code 26034 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates. However, it is essential to verify the coverage and reimbursement details with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information. Always consult the MPFS and your MAC to ensure compliance and accurate reimbursement for CPT code 26034.

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