CPT code 27059 is used for the surgical resection of a hip or pelvic tumor larger than 5 cm, helping to standardize billing and documentation.
CPT code 27059 is used to describe a surgical procedure involving the resection, or removal, of a tumor located in the hip or pelvic region that measures 5 centimeters or larger. This code indicates that the procedure is more complex due to the size of the tumor and the anatomical considerations involved in accessing and excising the tumor effectively.
When billing for the CPT code 27059, which pertains to the resection 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 78 - Unplanned Return to the Operating/Procedure Room
Used when a patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Indicates that a procedure is unrelated to the original procedure performed during the postoperative period.
7. Modifier LT - Left Side
Used to specify that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side
Used to specify that the procedure was performed on the right side of the body.
9. Modifier 22 - Increased Procedural Services
Indicates that the procedure was more complex than usual, warranting additional reimbursement.
10. Modifier 27 - Multiple Encounters on the Same Date
Used when a patient has multiple encounters on the same date of service.
It is essential for healthcare providers to carefully assess the specific circumstances of the procedure to determine the appropriate modifiers to use, ensuring accurate billing and compliance with payer requirements.
The CPT code 27059 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to ensure that there are no local coverage determinations (LCDs) or specific billing requirements that could affect reimbursement for CPT code 27059.
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 27059, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can streamline your RCM process and improve your bottom line.
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
