CPT code 27076 is for the surgical procedure to remove a tumor from the hip, including the acetabulum.
CPT code 27076 is for the surgical procedure that involves the resection of a tumor located in the hip, including the acetabulum, which is the socket of the hip joint. This procedure typically entails the removal of the tumor along with a portion of the surrounding bone to ensure complete excision and to address any potential malignancy. It is often performed to alleviate pain, restore function, or prevent the spread of cancerous cells in the hip region.
When billing for the CPT code 27076, there are several modifiers that may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used along with the reasons for their application:
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 or service was distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side
Used to specify that the procedure was performed on the left side of the body.
5. Modifier RT - Right Side
Used to specify that the procedure was performed on the right side of the body.
6. Modifier 22 - Increased Procedural Services
Indicates that the procedure was more complex than usual, warranting additional reimbursement.
7. Modifier 76 - Repeat Procedure or Service by Same Physician
Used when the same procedure is repeated by the same physician on the same day.
8. Modifier 77 - Repeat Procedure by Another Physician
Indicates that the same procedure was performed by a different physician.
9. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Used when a patient requires an unplanned return to the operating room for a related procedure within the global period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Indicates that a procedure was performed that is unrelated to the original procedure 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 27076 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, along with the corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 27076 may also depend on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region. MACs have the authority to implement local coverage determinations (LCDs) that can affect whether a particular service is reimbursed and under what circumstances. Therefore, it is advisable to consult both the MPFS and your local MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 27076.
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, including specific codes like 27076. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and 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
