CPT code 27067 is used for the removal or grafting of a hip bone lesion in medical billing and coding.
CPT code 27067 is used to describe the procedure of removing a bone lesion from the hip and, if necessary, grafting tissue to repair the area. This code indicates that the healthcare provider has performed a surgical intervention to address a specific abnormal growth or lesion in the hip bone, which may involve both excision and reconstruction to restore the integrity of the bone structure.
When billing for the CPT code 27067, there are several modifiers that 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 during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if the procedure is performed in conjunction with other procedures on the same day.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used if a subsequent procedure is planned or anticipated during the postoperative period.
4. Modifier 59 - Distinct Procedural Service: This modifier is applicable when the procedure is performed separately from other procedures on the same day, indicating that it is not a component of another service.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure: This modifier is used if a related procedure is performed due to complications from the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is appropriate if a completely unrelated procedure is performed during the postoperative period of the initial procedure.
8. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right hip.
9. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left hip.
Each of these modifiers serves to provide additional context for the procedure being billed, ensuring accurate reimbursement and compliance with coding guidelines.
CPT code 27067 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and any applicable guidelines for this code.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement for CPT code 27067. MACs are responsible for processing Medicare claims and may have localized policies that affect the reimbursement process.
Therefore, it is essential to consult both the MPFS and the relevant MAC for comprehensive information on the reimbursement criteria for CPT code 27067.
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