CPT code 27268 is for the treatment of a thigh fracture with a multi-part joint procedure, detailing the specific medical service provided.
CPT code 27268 is used to describe the surgical procedure for the treatment of a fracture in the thigh bone (femur) that involves the use of a plate and screws to stabilize the bone. This code specifically indicates that the fracture is complex and may involve multiple fragments, requiring a more intricate surgical approach to ensure proper alignment and healing.
When billing for CPT code 27268, which pertains to a complex procedure involving a thigh fracture with a multi-part joint, 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 CPT 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 22 - Increased Procedural Services
Indicates that the service provided was significantly more complex than typically required.
9. Modifier 27 - Multiple Encounters on the Same Date
Used when multiple encounters occur on the same date of service.
10. Modifier RT - Right Side
Indicates that the procedure was performed on the right side of the body.
11. Modifier LT - Left Side
Indicates that the procedure was performed on the left side of the body.
It is essential for healthcare providers to carefully assess the specific circumstances of the procedure to determine the appropriate modifiers to use, ensuring accurate billing and compliance with coding guidelines.
CPT code 27268 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 important to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 27268. Each MAC may have different guidelines and policies, so verifying with them ensures accurate and up-to-date information.
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. With RevFind, you can identify discrepancies for specific services, such as CPT code 27268, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your RCM process and improve your bottom line.
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