CPT code 27245 is used to describe the treatment of a thigh fracture through surgical procedures.
CPT code 27245 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 27245, 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 52 - Reduced Services: Use this modifier if the service provided is less than what is typically required for the procedure.
4. Modifier 53 - Discontinued Procedure: This modifier should be used if the procedure was started but had to be discontinued due to extenuating circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate 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 is applicable 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 should be used if a different procedure is performed by the same physician during the postoperative period of the original procedure.
9. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is applicable if an evaluation and management service is provided that is unrelated to the original procedure during the postoperative period.
It is essential to select the appropriate modifier(s) based on the specific circumstances surrounding the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 27245 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this particular CPT code is covered and the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare.
Additionally, it is essential to consult with your regional Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 27245. They can also offer guidance on any documentation requirements or billing nuances that may affect reimbursement.
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