CPT code 27222 is used to describe the treatment of a hip socket fracture, detailing the specific procedure performed by healthcare providers.
CPT code 27222 is used to describe the surgical procedure for treating a fracture of the hip socket, also known as the acetabulum. This code specifically refers to the open reduction and internal fixation of the fracture, which involves realigning the fractured bone and securing it with hardware to promote proper healing. This procedure is typically performed to restore stability and function to the hip joint, allowing the patient to regain mobility and reduce pain.
When billing for the CPT code 27222, which pertains to the treatment of a hip socket 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 hips.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if 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: This modifier is applicable when the 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 procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier applies if the patient requires a 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: Use this modifier if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
9. Modifier 90 - Reference (Outside) Laboratory: This modifier is used when laboratory tests are performed by a reference laboratory.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is applicable if a clinical diagnostic laboratory test is repeated on the same day.
It is essential to select the appropriate modifier based on the specific circumstances surrounding the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 27222 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this 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, it is essential to verify with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 27222.
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 RevFind, you can identify discrepancies related to CPT code 27222, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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