CPT code 27335 is used to describe the procedure for removing the knee joint lining, essential for accurate billing and documentation in healthcare.
CPT code 27335 is used to describe the surgical procedure for the removal of the knee joint lining, also known as the synovial membrane. This procedure is typically performed to alleviate pain and inflammation associated with conditions such as arthritis or other joint disorders. By excising the lining, the surgeon aims to improve joint function and reduce symptoms for the patient.
When billing for the CPT code 27335, which pertains to the removal of knee joint lining, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used:
1. Modifier 50 - Bilateral Procedure: This modifier is used when the procedure is performed on both knees during the same session.
2. Modifier 51 - Multiple Procedures: This modifier indicates that multiple procedures were performed during the same session, which may affect reimbursement.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is separate and distinct from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is appropriate if a different procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier LT - Left Side: This modifier specifies that the procedure was performed on the left knee.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right knee.
9. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier is used when the procedure is performed by a non-physician provider under the supervision of a physician.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
It is essential to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 27335 is subject to reimbursement by Medicare, but its eligibility and the amount reimbursed can vary. To determine if CPT code 27335 is reimbursed by Medicare, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare, including whether a specific CPT code is reimbursable and the associated payment amount.
Additionally, it is important to check with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage policies, including any local coverage determinations (LCDs) that may affect the reimbursement of CPT code 27335. By consulting both the MPFS and your MAC, you can ensure accurate and up-to-date information regarding the reimbursement status of CPT code 27335 under Medicare.
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 like those associated with CPT code 27335, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
