CPT code 27045 is used to describe the excision of a deep tumor in the hip or pelvic area measuring over 5 cm.
CPT code 27045 is used to describe a surgical procedure involving the excision of a deep tumor located in the hip or pelvic region, specifically when the tumor measures greater than 5 centimeters. This code indicates that the procedure is more complex due to the size and depth of the tumor, which may require specialized techniques and careful handling to ensure complete removal while minimizing damage to surrounding tissues.
When billing for CPT code 27045, which pertains to excision of a hip or pelvic tumor greater than 5 cm, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 59 - Distinct Procedural Service
Used to indicate that a procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
Applied when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
Used when the same procedure is repeated by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Indicates that a patient returned 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
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier 22 - Increased Procedural Services
Indicates that the work required to provide a service is substantially greater than typically required.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
Used when an evaluation and management service is provided that is unrelated to the procedure performed.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Indicates that multiple evaluation and management encounters occurred on the same day.
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 27045 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should refer to the MPFS.
Additionally, it is essential to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as they may have specific local coverage determinations (LCDs) or other directives that could impact reimbursement for CPT code 27045.
Always ensure that the service meets Medicare's medical necessity criteria and documentation requirements to facilitate proper reimbursement.
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 CPT code 27045 and ensure you are receiving the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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