CPT code 27236 is used to describe the treatment of a thigh fracture through surgical procedures.
CPT code 27236 is used to describe the surgical procedure for the treatment of a fracture in the femur, which is the thigh bone. This code specifically refers to the open reduction and internal fixation of a femoral fracture, indicating that the bone has been realigned and stabilized using surgical methods, such as plates or screws, to promote proper healing.
When billing for CPT code 27236, 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 should be applied if multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional: This modifier is appropriate if the procedure is part of a staged treatment plan.
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 applicable 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.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure: This modifier is relevant 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: 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 if the service is 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.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements.
The CPT code 27236 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 27236. To determine the exact reimbursement amount, healthcare providers should refer to the MPFS, which is updated annually.
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 payment rates for CPT code 27236. Providers should consult their respective MAC for detailed guidance on billing and reimbursement for this code.
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. With RevFind, you can identify discrepancies for specific CPT code 27236, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your RCM process and improve your bottom line.
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