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25605 with 76000


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Auditing charges in our ortho department and am stumped.:confused:
One of our managers coded 25605 with 76000 modifier 26. I though that 25605 included procedure 76000 so my thought was this is incorrect and only 25605 should be billed. Our PMS has code correct and when I performed the code check on this it stated that 25605 can be used if a modifier 59 is used.

My question is why code for it if it is already included in the primary procedure code?

Any thoughts would be greatly appreciated!


True Blue
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You are right--it is considered part of 25605. The 76000 bundles with the 25605. By adding the 59 modifier she is unbundling. (unless of course the fluoro is on a different body part other than the fracture)