CPT code 27248 is used to describe the treatment of a thigh fracture through surgical procedures.
CPT code 27248 is used to describe the surgical procedure for treating a fracture of the femur, specifically in the thigh area. This code indicates that the healthcare provider has performed an open reduction and internal fixation of the femoral shaft 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 27248, 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 with this code, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
Used when a subsequent procedure is planned or anticipated during the postoperative period.
4. Modifier 59 - Distinct Procedural Service
Indicates that a procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the same procedure is repeated by the same provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
Indicates an unplanned return to the operating room for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier LT - Left Side
Indicates that the procedure was performed on the left side of the body.
9. Modifier RT - Right Side
Indicates that the procedure was performed on the right side of the body.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
Used when a non-physician provider assists in the surgical procedure.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27248 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and determining coverage specifics in their respective jurisdictions.
Therefore, healthcare providers should consult the MPFS and their local MAC to confirm the exact reimbursement rates and any regional variations for CPT code 27248.
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