CPT code 27198 is a medical billing code used for closed treatment of pelvic ring fractures.
CPT code 27198 is used to describe a closed treatment of a pelvic ring fracture. This procedure involves the manipulation and stabilization of the fractured pelvic bones without making any incisions. It is typically performed to restore the normal alignment and function of the pelvis, allowing for proper healing and recovery.
When billing for CPT code 27198 (Closed treatment of pelvic ring fracture), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
Used when a procedure is planned or anticipated to be staged or is a subsequent procedure related to the initial procedure.
4. Modifier 59 - Distinct Procedural Service
Indicates that a procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the same procedure is repeated by the same provider on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional
Indicates that the same procedure was performed by a different provider.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
Used when a patient returns for a related procedure within the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Indicates that a procedure unrelated to the original procedure was performed during the postoperative period.
9. Modifier 90 - Reference (Outside) Laboratory
Used when laboratory tests are performed by a reference laboratory.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
Indicates that a clinical diagnostic laboratory test was repeated on the same day.
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 27198 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. To determine the exact reimbursement rate and any potential coverage limitations for CPT code 27198, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the respective Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide detailed information on local coverage determinations (LCDs) and any specific documentation requirements. Each MAC may have unique guidelines that could affect the reimbursement process for CPT code 27198.
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