CPT code 26991 is for the drainage of a pelvis bursa, a procedure to remove fluid buildup in that area.
CPT code 26991 is used to describe the procedure of draining fluid from a bursa located in the pelvis. This typically involves the use of a needle or other instruments to remove excess fluid that may be causing discomfort or inflammation in the bursa, which is a small sac filled with lubricating fluid that helps reduce friction between tissues in the body.
When billing for the CPT code 26991 (Drainage of pelvis bursa), the following modifiers may be applicable, depending on the specific circumstances of the procedure:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the drainage procedure is performed bilaterally on both sides of the body.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session, indicating that the primary procedure is being billed along with additional procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed on a separate site or distinct from other procedures performed on the same day, indicating that it should be reimbursed separately.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the drainage procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable if the patient requires a return to the operating room for a related procedure within the global period of the initial procedure.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used if a different procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right side of the body.
9. Modifier AS - Physician Assistant/ Nurse Practitioner/ Clinical Nurse Specialist Services: This modifier is used when the service is performed by a non-physician practitioner under the supervision of a physician.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
CPT code 26991 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable coverage limitations, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the relevant Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 26991.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. With RevFind, you can identify discrepancies for specific codes like 26991, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
