CPT code 27235 is used to describe the treatment of a thigh fracture through surgical procedures.
CPT code 27235 is used to describe the surgical procedure for treating a fracture of the femur, specifically in the thigh area. This code indicates that the healthcare provider has performed an open reduction and internal fixation of the femoral shaft fracture, which may involve the use of hardware such as plates or screws to stabilize the bone and promote healing.
When billing for CPT code 27235, 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 or Service by the Same Physician During the Postoperative Period: Use this modifier if a subsequent procedure is planned during the postoperative period of the initial procedure.
4. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is distinct or independent from other services performed on the same day.
5. 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.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure: This modifier is applicable if an unplanned return to the operating room is necessary for a related procedure.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if a completely unrelated procedure is performed during the postoperative period.
9. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left thigh.
10. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right thigh.
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 27235 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, the reimbursement for CPT code 27235 may vary depending on the local policies of the Medicare Administrative Contractor (MAC) that services your geographic area.
It is essential to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement rates and any additional requirements or restrictions that may apply.
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