CPT code 27165 is for the surgical procedure involving incision and fixation of the femur, typically used in orthopedic treatments.
CPT code 27165 is for the surgical procedure involving the incision and fixation of the femur, which is the thigh bone. This code is used when a healthcare provider performs a surgical intervention to repair a fracture or stabilize the femur, often through the use of hardware such as plates or screws. This procedure is typically indicated for patients with significant femoral fractures or instability that requires surgical correction to promote proper healing and restore function.
When billing for CPT code 27165, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used, along with the reasons for their application:
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 when multiple procedures are performed during the same session.
3. Modifier 52 - Reduced Services: Use this modifier if the service provided is partially reduced or eliminated at the physician's discretion.
4. Modifier 53 - Discontinued Procedure: This modifier should be used if the procedure was started but had to be discontinued due to extenuating circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when 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 applicable when the same procedure is performed again by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if a patient requires an unplanned 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 used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
9. Modifier 22 - Increased Procedural Services: This modifier may be used 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 applicable when an unrelated E/M service is provided during the postoperative period.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements.
CPT code 27165 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including CPT code 27165. 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 the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on coverage and reimbursement rates for CPT code 27165. Providers should consult their local MAC for detailed information on any regional variations or additional requirements that may affect reimbursement for this specific 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 and by individual payer. For instance, with RevFind, you can identify discrepancies related to CPT code 27165, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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