CPT code 27246 is used to describe the treatment of a thigh fracture through surgical procedures.
CPT code 27246 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 treatment of a femoral fracture, typically involving the use of internal fixation devices such as plates or screws to stabilize the bone and promote healing. This procedure is essential for restoring the structural integrity of the thigh and enabling the patient to regain mobility.
When billing for CPT code 27246, 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 appropriate if multiple procedures are performed during the same session.
3. Modifier 52 - Reduced Services: This modifier may be used if the service provided is less than what is typically required for the procedure.
4. Modifier 53 - Discontinued Procedure: This modifier should be applied if the procedure was started but had to be discontinued due to extenuating circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is applicable 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 complications related to the initial procedure.
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 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.
The CPT code 27246 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, along with the corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 27246 can also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and may have additional local coverage determinations (LCDs) that affect whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult both the MPFS and your regional MAC to confirm the reimbursement status and any specific requirements for CPT code 27246.
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