CPT code 27065 is for the surgical removal of a hip bone lesion, helping healthcare providers bill for this specific procedure accurately.
CPT code 27065 is used to describe the surgical procedure for the removal of a bone lesion from the hip area. This code specifically indicates that the lesion is located in the hip joint or surrounding bone structures, and the procedure involves excising or removing the affected bone tissue to address issues such as tumors, infections, or other abnormalities.
When billing for the CPT code 27065, which pertains to the removal of a hip bone lesion, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both hips.
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: This modifier is appropriate when the procedure is performed on a separate site or distinct from other procedures performed on the same day.
4. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left hip.
5. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right hip.
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: This modifier is applicable 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 can be used 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 relevant if a return to the operating room is necessary for a related procedure within 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 used if a procedure unrelated to the original surgery 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 27065 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, it is important to note that the final determination of reimbursement for CPT code 27065 may also depend on the policies of the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and can have localized policies that affect reimbursement. Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 27065.
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 27065 and ensure you are receiving the correct reimbursements. Schedule a demo today to see how our solution can help you optimize your revenue.
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
