CPT code 27279 is for the arthrodesis of the sacroiliac joint, a procedure to fuse the joint for pain relief and stability.
CPT code 27279 is used to describe a procedure involving the arthrodesis, or surgical fusion, of the sacroiliac joint. This procedure is performed to alleviate pain and improve function in patients suffering from sacroiliac joint dysfunction. The term "perq/min nvas" indicates that the procedure is done using a percutaneous approach, meaning it is minimally invasive, and involves the use of navigation assistance for precision during the surgery.
When billing for CPT code 27279, 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 sides of the body.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier indicates that a procedure or service was distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left side of the body.
5. Modifier RT - Right Side: This modifier is used to indicate that the procedure was performed on the right side of the body.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
7. Modifier 26 - Professional Component: This modifier is applicable when billing for the professional component of a service that has both professional and technical components.
8. Modifier TC - Technical Component: Use this modifier when billing for the technical component of a service that has both professional and technical components.
9. Modifier 78 - Return to the Operating Room for a Related Procedure: This modifier is used if a patient returns to the operating room for a related procedure during the postoperative period.
10. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: This modifier indicates that a procedure was performed 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 of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 27279 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 27279. Each MAC may have unique policies that influence how this code is processed and reimbursed.
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 CPT code 27279, 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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