CPT code 20827 is for the surgical procedure of reattaching a completely severed thumb.
CPT code 20827 is for the surgical procedure of reattaching a completely severed thumb. This involves reconnecting bones, tendons, nerves, and blood vessels to restore function and appearance.
For CPT code 20827 (Replantation, thumb, complete), the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required. This could be due to complications or other factors that increased the complexity of the replantation.
2. Modifier 51 - Multiple Procedures: If multiple procedures were performed during the same surgical session, this modifier should be appended to indicate that more than one procedure was carried out.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if a subsequent procedure is planned or staged and is related to the initial procedure.
4. Modifier 59 - Distinct Procedural Service: Apply this modifier when the replantation procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician: Use this modifier if the same procedure needs to be repeated by the same physician.
6. 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 requires an unplanned return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
8. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left thumb.
9. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right thumb.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
Medicare reimbursement for CPT code 20827, which pertains to the replantation of a complete thumb, is subject to specific criteria and guidelines. Generally, Medicare does cover this procedure as it is considered medically necessary for the restoration of function and appearance following traumatic amputation. However, the exact reimbursement amount can vary based on several factors, including geographic location, the setting of the procedure (inpatient vs. outpatient), and the specific Medicare Administrative Contractor (MAC) policies.
To determine the precise reimbursement amount for CPT code 20827, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or contact their local MAC. As of the latest updates, the national average reimbursement for this procedure can range significantly, so it is crucial to verify the current rates and any applicable adjustments.
For the most accurate and up-to-date information, providers can use the CMS Physician Fee Schedule Look-Up Tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool allows providers to input the CPT code and obtain detailed information on reimbursement rates, including any geographic adjustments.
In summary, while Medicare does reimburse for CPT code 20827, the specific amount will depend on various factors, and providers should consult the MPFS or their local MAC for precise details.
Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 20827 for thumb replantation. Ensure you're receiving the full reimbursement you deserve from every payer. Schedule a demo today to see RevFind in action and protect your revenue.
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