CPT code 27240 is used to describe the surgical treatment of a thigh fracture, detailing the specific procedure performed.
CPT code 27240 is used to describe the surgical procedure for treating a fracture of the femur, which is the thigh bone. This code specifically refers to the open treatment of a femoral fracture, typically involving the use of internal fixation methods, such as plates or screws, to stabilize the bone and promote proper healing. This procedure is essential for restoring function and mobility to patients who have sustained a significant injury to the thigh.
When billing for CPT code 27240, 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 when multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier is appropriate if the procedure is part of a staged treatment plan or if it is a subsequent procedure related to the initial treatment.
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: This modifier should be used if the patient requires a return to the operating room for a related procedure within the global period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is appropriate if a different procedure is performed by the same physician during the postoperative period of the initial procedure.
9. Modifier 90 - Reference (Outside) Laboratory: This modifier is used if laboratory tests related to the procedure are sent to an outside laboratory.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is applicable if the same laboratory test is performed more than once on the same day.
It is essential to evaluate the specific circumstances surrounding the procedure to determine the appropriate modifiers to use for accurate billing and compliance.
CPT code 27240 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 27240. To determine the exact reimbursement rate, 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 guidance on the reimbursement for CPT code 27240. Providers should consult their respective MAC for detailed information on coverage policies, documentation requirements, and any potential local coverage determinations (LCDs) that might affect 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. For instance, with the CPT code 27240, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
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