CPT code 27005 is a medical billing code used for the incision of hip tendon procedures in healthcare settings.
CPT code 27005 is for the surgical procedure involving the incision of a hip tendon. This code is used to describe the specific action taken to access and potentially repair or modify the tendon in the hip area, which may be necessary due to injury, inflammation, or other conditions affecting hip function.
When billing for the CPT code 27005, various modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both hips during the same session.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session, including the primary procedure represented by CPT code 27005.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed separately from other procedures on the same day, indicating that it is not a routine part of the other services provided.
4. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left hip specifically.
5. Modifier RT - Right Side: This modifier should be used if the procedure is performed on the right hip specifically.
6. Modifier 22 - Increased Procedural Services: This modifier may be applicable if the procedure required significantly more work than typically required, justifying additional reimbursement.
7. Modifier 26 - Professional Component: If the procedure involves a professional component that is billed separately, this modifier should be used.
8. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: This modifier is relevant if the patient has multiple evaluation and management encounters on the same day as the procedure.
9. Modifier 78 - Return to the Operating Room for a Related Procedure: This modifier is used if the patient requires a return to the operating room for a related procedure within the global period of the original procedure.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: This modifier is appropriate if a different procedure is performed during the postoperative period that is unrelated to the original procedure.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27005 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, MACs, which are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims, can offer more localized information regarding coverage and reimbursement specifics.
Therefore, while CPT code 27005 is generally reimbursed by Medicare, consulting the MPFS and your MAC will provide the most accurate and up-to-date information.
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. For instance, with CPT code 27005, you can ensure that every dollar is accounted for. Schedule a demo today to see how RevFind can help you identify and rectify underpayments effectively.
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