CPT code 27217 is used to describe the treatment of a pelvic ring fracture in medical billing and coding.
CPT code 27217 is used to describe the surgical treatment of a pelvic ring fracture. This code specifically refers to the procedure where a healthcare provider performs an open reduction and internal fixation of the pelvic ring, which involves realigning the fractured bones and stabilizing them with hardware to promote proper healing. This procedure is typically indicated for patients with significant pelvic fractures that may affect stability and function.
When billing for the CPT code 27217, which pertains to the treatment of a 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 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 performed that is unrelated to the original procedure 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 assess the specific circumstances of the procedure to determine the appropriate modifiers to use when billing for CPT code 27217. Proper use of modifiers can help ensure accurate reimbursement and compliance with payer requirements.
CPT code 27217 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. To determine the exact reimbursement for CPT code 27217, healthcare providers should refer to the MPFS.
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 information regarding coverage and reimbursement rates for CPT code 27217. Providers should consult their respective MAC for detailed guidance on billing and reimbursement for this specific code.
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