CPT code 27146 is a medical billing code used for the incision of the hip bone, helping healthcare providers document and bill for this procedure.
CPT code 27146 is the procedure for the incision of the hip bone. This code is used to describe a surgical intervention where an incision is made in the hip bone, typically to access the joint or surrounding structures for treatment of conditions such as fractures, infections, or other orthopedic issues. This procedure may involve removing bone fragments, draining fluid, or performing repairs to improve hip function and alleviate pain.
When billing for CPT code 27146 (Incision of hip bone), the following modifiers may be applicable, depending on the specific circumstances of the procedure:
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 incision of the hip bone is performed alongside other surgical procedures during the same operative session.
3. Modifier 58 - Staged or Related Procedure: This modifier should be used if the procedure is part of a staged or related procedure that is performed 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 distinct or independent.
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: This modifier is relevant if the patient requires a return to the operating room for a related procedure within the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is appropriate if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
8. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right hip.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left hip.
Each of these modifiers serves to provide additional context for the procedure, ensuring accurate billing and compliance with payer requirements.
Determining if CPT code 27146 is reimbursed by Medicare involves checking the Medicare Physician Fee Schedule (MPFS) and consulting with your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To verify if CPT code 27146 is reimbursed, you should first access the MPFS database, which is available on the Centers for Medicare & Medicaid Services (CMS) website. Enter the specific CPT code to see if it is listed and to review the associated reimbursement details.
Additionally, it is crucial to consult with your regional MAC, as they are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 27146. Each MAC may have unique interpretations and additional requirements, so their input is invaluable for ensuring compliance and accurate billing.
In summary, to determine if CPT code 27146 is reimbursed by Medicare, you need to review the MPFS and consult with your regional MAC for the most accurate and up-to-date information.
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 27146 and ensure you are receiving the correct reimbursement. 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
