CPT code 27339 is for excising a tumor from the thigh or knee that is larger than 5 cm, ensuring accurate billing and documentation in healthcare.
CPT code 27339 is used to describe a surgical procedure involving the excision of a tumor located in the thigh or knee area, specifically when the tumor is larger than 5 centimeters. This code indicates that the procedure involves the removal of the tumor along with some surrounding tissue to ensure complete excision and minimize the risk of recurrence.
When billing for CPT code 27339, which pertains to excision of a thigh or knee tumor greater than 5 cm, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with this code, along with the reasons for their use:
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 59 - Distinct Procedural Service
Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Indicates that a procedure was repeated by the same provider.
5. 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
Used when a patient requires a return to the operating room for a related procedure within the postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Indicates that a procedure was performed that is unrelated to the original procedure during the postoperative period.
7. Modifier 22 - Increased Procedural Services
Used when the work required to provide a service is substantially greater than typically required.
8. Modifier 26 - Professional Component
Indicates that only the professional component of a service is being billed.
9. Modifier TC - Technical Component
Used when only the technical component of a service is being billed.
10. Modifier KX - Requirements Met
Used to indicate that specific requirements have been met for certain services or items, often related to coverage criteria.
Each of these modifiers serves a specific purpose and should be applied based on the clinical scenario and documentation to ensure accurate billing and compliance with payer requirements.
The reimbursement of CPT code 27339 by Medicare depends on its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for your region.
To determine if CPT code 27339 is reimbursed, you should first consult the MPFS, which provides a comprehensive list of services covered by Medicare along with their corresponding reimbursement rates.
Additionally, it is essential to review the local coverage determinations (LCDs) and national coverage determinations (NCDs) issued by your MAC, as these documents provide detailed information on the coverage criteria and any specific requirements for reimbursement.
By cross-referencing these resources, you can ascertain whether CPT code 27339 is eligible for Medicare reimbursement.
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 27339, 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 address underpayments effectively.
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