CPT code 27238 is used to describe the treatment of a thigh fracture through surgical procedures.
CPT code 27238 is used to describe the surgical procedure for the treatment of a fracture in the thigh bone (femur). 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 27238, which pertains to the treatment of a thigh 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:
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 During the Postoperative Period: This modifier is appropriate if a subsequent procedure is planned 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 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 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 used 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 applied if a procedure unrelated to the original procedure is performed during the postoperative period.
9. Modifier LT - Left Side: Use this modifier 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.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements.
CPT code 27238 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. However, the final determination of reimbursement for CPT code 27238 may also depend on the policies of the local Medicare Administrative Contractor (MAC). Each MAC has the authority to establish local coverage determinations (LCDs) that can influence whether and how a particular CPT code is reimbursed. Therefore, it is essential to consult both the MPFS and the relevant MAC guidelines to confirm the reimbursement status for CPT code 27238.
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