CPT code 27202 is used to describe the treatment of a tailbone fracture, detailing the specific medical procedure performed.
CPT code 27202 is used to describe the surgical procedure for the treatment of a tailbone fracture, specifically involving the manipulation or stabilization of the coccyx. This code indicates that the healthcare provider performed an intervention to address the fracture, which may include realignment or fixation to promote healing and alleviate pain.
When billing for CPT code 27202, which pertains to the treatment of a tailbone fracture, 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 if 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 another 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: Use this modifier if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is applicable if the same procedure is repeated 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 during the postoperative period.
8. 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.
9. Modifier 90 - Reference (Outside) Laboratory: This modifier is applicable if the service is performed by a reference laboratory.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if a laboratory test is repeated on the same day.
It is essential to select the appropriate modifier based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27202 is reimbursed by Medicare, but the reimbursement is subject to specific guidelines and conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS. Additionally, it is essential to verify with the respective Medicare Administrative Contractor (MAC) for any regional variations or specific local coverage determinations that may affect reimbursement for CPT code 27202.
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 CPT code 27202, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
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