CPT code 27215 is used to describe the treatment of pelvic fractures in healthcare billing and documentation.
CPT code 27215 is used to describe the surgical treatment of pelvic fractures. This code specifically refers to the procedures involved in stabilizing and repairing fractures in the pelvic region, which may include the use of internal fixation devices or other surgical techniques to ensure proper alignment and healing of the bones. It is essential for healthcare providers to accurately use this code to reflect the complexity and nature of the surgical intervention performed on patients with pelvic injuries.
When billing for the CPT code 27215, which pertains to the treatment of pelvic fractures, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
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 performed in a staged manner.
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.
6. 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
Indicates an unplanned return to the operating room for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Used when a procedure is unrelated to the original procedure performed during the postoperative period.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right side of the body.
9. Modifier LT - Left Side
Indicates that the procedure was performed on the left side of the body.
10. Modifier 22 - Increased Procedural Services
Used when the work required to provide a service is substantially greater than typically required.
It is essential for healthcare providers to carefully assess the specific circumstances of the procedure to determine the appropriate modifiers to use, ensuring accurate billing and compliance with payer requirements.
CPT code 27215 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.
To determine if this particular CPT code is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and can provide region-specific information regarding reimbursement.
It is advisable to check with the relevant MAC for the most accurate and up-to-date information on the reimbursement status of CPT code 27215.
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 27215, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you maximize your revenue and minimize losses.
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