CPT code 27286 is a medical billing code used for the surgical fusion of the hip joint, helping providers accurately report and receive payment for the procedure.
CPT code 27286 is the code used to describe the surgical procedure for the fusion of the hip joint. This procedure involves the surgical joining of the bones in the hip to eliminate movement and alleviate pain, often performed in cases of severe arthritis or injury. The goal of this surgery is to stabilize the joint and improve the patient's overall function.
When billing for the CPT code 27286 (Fusion of hip joint), 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 fusion is performed on both hips during the same surgical session.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if the hip fusion is performed alongside other surgical procedures during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier should be used if the hip fusion is part of a staged procedure or if it is a subsequent procedure related to a previous surgery.
4. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the hip fusion is performed separately from other procedures that may be considered part of the same surgical session.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the hip fusion procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating Room: This modifier is applicable if the patient requires an unplanned return to the operating room for complications related to the hip fusion.
7. Modifier 79 - Unrelated Procedure by Same Physician: Use this modifier if the hip fusion is performed during the same session as an unrelated procedure by the same physician.
8. Modifier RT - Right Side: This modifier is used to indicate that the procedure was performed on the right hip.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left hip.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier is used if the procedure is performed by a non-physician practitioner under the supervision of a physician.
It is essential to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 27286 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of the payment rates for services covered by Medicare, including CPT code 27286. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing Medicare claims and can provide region-specific information regarding the reimbursement of CPT code 27286. Each MAC may have slightly different guidelines and rates, so it is essential to consult the appropriate MAC for the most 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. For instance, with CPT code 27286, 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 recover lost revenue.
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