CPT code 27130 is a medical billing code for total hip arthroplasty, a surgical procedure to replace a damaged hip joint.
CPT code 27130 is for a total hip arthroplasty, which is a surgical procedure that involves replacing the entire hip joint with a prosthetic implant. This procedure is typically performed to relieve pain and improve function in patients suffering from severe hip arthritis or other hip joint disorders. The surgery aims to restore mobility and enhance the quality of life for individuals with debilitating hip conditions.
When billing for CPT code 27130 (Total hip arthroplasty), 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 total hip arthroplasty is performed on both hips during the same surgical session.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if the total hip arthroplasty is performed in conjunction with other surgical procedures on the same day.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used to indicate that the total hip arthroplasty is a separate and distinct procedure from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the total hip arthroplasty is performed more than once by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for complications related to the total hip arthroplasty within the global period.
6. 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 total hip arthroplasty.
7. Modifier RT - Right Side: Use this modifier if the total hip arthroplasty is performed on the right hip.
8. Modifier LT - Left Side: Use this modifier if the total hip arthroplasty is performed on the left hip.
9. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier may be used if the procedure is performed by a non-physician practitioner under the supervision of a physician.
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.
CPT code 27130 is reimbursed by Medicare, but the reimbursement amount can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 27130. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and determining coverage specifics. Each MAC may have localized policies and guidelines that can influence the reimbursement process for CPT code 27130. Therefore, it is advisable for healthcare providers to consult their respective MAC for detailed information on coverage and reimbursement rates for this specific CPT code.
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 27130. 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
