CPT code 27230 is used to describe the treatment of a thigh fracture through surgical procedures.
CPT code 27230 is used to describe the surgical procedure for the treatment of a fracture in the femur, commonly known as the thigh bone. This code specifically refers to the open reduction and internal fixation of a femoral fracture, which involves realigning the broken bone and securing it with hardware such as plates or screws to promote proper healing.
When billing for CPT code 27230, which pertains to the treatment of a thigh 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 thighs.
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 part of a staged treatment plan or if it is a subsequent procedure related to the initial treatment.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating Room: This modifier is appropriate if the patient requires an unplanned return to the operating room for complications related to the initial procedure.
6. Modifier 79 - Unrelated Procedure by Same Physician: Use this modifier if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
7. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
8. Modifier 26 - Professional Component: This modifier is applicable if the service is being billed separately for the professional component of the procedure.
9. Modifier TC - Technical Component: Use this modifier if billing for the technical component of the procedure separately.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is relevant if the procedure involves repeat diagnostic tests 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 27230 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) have jurisdiction over different geographic areas and may have specific local coverage determinations (LCDs) that affect payment. Therefore, it is advisable to consult the MPFS and the relevant MAC for precise information regarding the reimbursement of CPT code 27230.
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