CPT code 27284 is a medical billing code used to describe the surgical procedure for fusion of the hip joint.
CPT code 27284 is the designation for the surgical procedure involving the fusion of the hip joint. This procedure is typically performed to alleviate pain and restore function in patients suffering from severe hip joint conditions, such as arthritis or trauma. During the fusion, the surgeon joins the bones of the hip joint together, which can help stabilize the joint and reduce discomfort, ultimately leading to improved mobility for the patient.
When billing for the CPT code 27284 (Fusion of hip 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, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both hips.
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 the procedure is part of a staged treatment plan or a subsequent procedure related to the initial procedure.
4. Modifier 59 - Distinct Procedural Service
Indicates that the 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 performed again 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
Indicates that a return to the operating room was necessary due to complications or related issues from the initial 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 procedure required significantly more work than typically required.
9. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Used when multiple evaluation and management services are provided on the same day.
10. Modifier 33 - Preventive Services
Indicates that the procedure is preventive in nature, if applicable.
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 27284 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT code 27284 is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare. Additionally, it is essential to check with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and any local coverage determinations (LCDs) that may affect reimbursement.
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