CPT code 27299 is an unlisted procedure code for the pelvis or hip joint, used when no specific code exists for a particular service.
CPT code 27299 is used to describe an unlisted procedure related to the pelvis or hip joint. This code is typically employed when a specific procedure does not have a designated code within the Current Procedural Terminology (CPT) system. It allows healthcare providers to report a unique surgical intervention or treatment performed on the pelvis or hip joint that may not be explicitly defined by other existing codes. When using this code, it is essential to provide detailed documentation to justify the procedure and explain why a specific code was not applicable.
When billing for CPT code 27299 (Unlisted procedure, pelvis or hip joint), the following modifiers may be applicable, depending on the specific circumstances of the procedure performed:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the procedure requires significantly more work than typically required. It indicates that the complexity or time involved in the procedure was greater than usual.
2. Modifier 50 - Bilateral Procedure: If the procedure is performed on both sides of the body, this modifier should be used to indicate that the service was bilateral.
3. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same session. It indicates that more than one procedure was performed.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is often used to clarify that the unlisted procedure was separate from other procedures.
5. Modifier 76 - Repeat Procedure by Same Physician: If the unlisted procedure is performed more than once by the same physician on the same day, this modifier should be used to indicate the repeat service.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the same procedure is performed by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If the procedure requires an unplanned return to the operating room within the global period, this modifier should be used.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if a procedure unrelated to the original procedure is performed during the postoperative period.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: If applicable, this modifier indicates that a laboratory test was repeated on the same day.
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.
Determining if CPT code 27299 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) for your specific region. CPT code 27299 is categorized as an unlisted procedure code, which means it does not have a predetermined reimbursement rate under the MPFS.
For unlisted codes like 27299, reimbursement is not straightforward and typically requires additional documentation to justify the medical necessity and the specifics of the procedure performed. The MAC will review the submitted documentation and determine the appropriate reimbursement on a case-by-case basis. Therefore, while CPT code 27299 can be reimbursed by Medicare, it requires a detailed submission and approval process through your regional MAC.
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 CPT code 27299 and ensure you are receiving the correct reimbursements. Schedule a demo today to see how our solution can help you optimize your revenue.
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