CPT code 27218 is used to describe the treatment of a pelvic ring fracture in medical billing and coding.
CPT code 27218 is used to describe the surgical treatment of a pelvic ring fracture. This code specifically refers to the procedures involved in stabilizing and repairing fractures in the pelvic ring, which may include the use of internal fixation devices to ensure proper alignment and healing of the bones. This code is essential for healthcare providers to accurately document and bill for the surgical intervention required to address this type of injury.
When billing for the CPT code 27218, 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: 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: This modifier should be used if the procedure is a staged or related procedure that is performed during the postoperative period.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the same procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure is performed by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable if the 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 should be used if a procedure unrelated to the original procedure is performed during the postoperative period.
9. Modifier 90 - Reference (Outside) Laboratory: This modifier is used when laboratory services are provided by a reference laboratory.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is applicable when a clinical diagnostic laboratory test is 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.
The CPT code 27218 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors.
To determine if CPT code 27218 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, it is essential to check with the local Medicare Administrative Contractor (MAC) for any region-specific guidelines or coverage determinations that may affect reimbursement.
The MACs are responsible for processing Medicare claims and can provide detailed information on whether CPT code 27218 is covered and the conditions under which it is reimbursed.
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, including specific codes like 27218. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue.
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