CPT code 27170 is for the surgical repair or grafting of the femur head or neck, commonly used in orthopedic procedures.
CPT code 27170 is used to describe a surgical procedure involving the repair or grafting of the femoral head or neck. This procedure is typically performed to address issues such as fractures, avascular necrosis, or other conditions affecting the hip joint. The goal of the surgery is to restore the structural integrity and function of the femur, which is crucial for mobility and overall hip health.
When billing for CPT code 27170 (Repair/graft femur head/neck), 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 when multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: Use this modifier if the procedure is a staged or related procedure that is performed during the postoperative period of a previous procedure.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right side of the body.
9. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left side of the body.
10. Modifier AS - Physician Assistant/ Nurse Practitioner/ Clinical Nurse Specialist: This modifier is used when the procedure is performed by a non-physician provider under the supervision of a physician.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27170 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and rates outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement amount and any additional requirements, healthcare providers should consult the MPFS, which is updated annually. Additionally, Medicare Administrative Contractors (MACs) may have localized policies and guidelines that could affect reimbursement. It is essential for providers to verify with their respective MAC to ensure compliance with all Medicare billing requirements for CPT code 27170.
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