CPT code 27048 is for excising a deep tumor in the hip or pelvis that is less than 5 cm in size.
CPT code 27048 is used to describe a surgical procedure involving the excision of a tumor located in the hip or pelvic region that is deep and measures less than 5 centimeters in size. This code indicates that the procedure is focused on removing a tumor while considering its depth and size, which can impact the complexity and approach of the surgery.
When billing for CPT code 27048, modifiers may be required to provide additional information about the procedure performed. Below is a list of modifiers that could be applicable, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both hips/pelvis.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: This modifier is used when the procedure is performed on the left hip/pelvis.
5. Modifier RT - Right Side: This modifier is used when the procedure is performed on the right hip/pelvis.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period: Use this modifier if an unrelated service is provided during the postoperative period.
8. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: This modifier is applicable if multiple evaluation and management services are provided on the same day.
9. Modifier 78 - Return to the Operating Room for a Related Procedure During the Postoperative Period: This modifier is used if a related procedure is performed in the operating room during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: This modifier is applicable if an unrelated procedure is performed during the postoperative period.
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 27048 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 27048.
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