CPT code 27111 is for the transfer of the iliopsoas muscle, a procedure used to treat certain hip and pelvic conditions.
CPT code 27111 is the procedure for transferring the iliopsoas muscle, which is a major muscle group in the hip region. This surgical intervention is typically performed to address issues such as hip instability or to improve function in patients with certain conditions affecting the hip joint. The transfer involves repositioning the muscle to enhance its effectiveness in stabilizing the hip or to restore movement.
When billing for CPT code 27111, 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 sides of the body.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple procedures are performed during the same session.
3. Modifier 52 - Reduced Services: This modifier should be used if the service provided is less than what is typically required for the procedure.
4. Modifier 53 - Discontinued Procedure: If the procedure was started but had to be discontinued due to extenuating circumstances, this modifier should be applied.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure is performed again by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is appropriate if the same procedure is performed again by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if a patient requires a return to the operating room for a related procedure within the global period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if a different procedure is performed by the same physician during the postoperative period of the original procedure.
9. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is used if an evaluation and management service is provided that is unrelated to the original procedure during the postoperative period.
Each of these modifiers serves a specific purpose and helps to provide additional context for the services rendered, ensuring accurate billing and reimbursement.
The CPT code 27111 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and guidelines for services covered under Medicare Part B.
Additionally, the reimbursement for CPT code 27111 may vary depending on the local coverage determinations (LCDs) set by the Medicare Administrative Contractor (MAC) for your region. It is essential to consult the MPFS and your regional MAC to understand the exact reimbursement criteria and any potential restrictions or documentation requirements for CPT code 27111.
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 CPT codes, such as 27111, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your processes 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
