CPT code 27305 is a medical billing code used for incising the thigh tendon and fascia during surgical procedures.
CPT code 27305 is used to describe a surgical procedure involving the incision of the thigh tendon and fascia. This code indicates that a healthcare provider has performed an operation to cut through the tendon and the surrounding connective tissue in the thigh area, typically to address issues such as tendon injuries or to facilitate access to underlying structures for further treatment.
When billing for the CPT code 27305, there are several modifiers that 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 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 was 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 greater than what is typically required for the procedure.
9. Modifier 27 - Multiple Encounters on the Same Date
Used when a patient has multiple encounters on the same date of service.
10. Modifier 53 - Discontinued Procedure
Indicates that a procedure was terminated due to extenuating circumstances or those that threatened the well-being of the patient.
It is essential to select the appropriate modifier(s) based on the specific circumstances surrounding the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27305 is reimbursed by Medicare, but the reimbursement is subject to the guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for their services.
Additionally, the specific reimbursement rates and policies for CPT code 27305 may vary depending on the region, as they are also influenced by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to implement and interpret Medicare policies within their jurisdiction, which can affect the final reimbursement amount and any additional requirements for this CPT code.
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