CPT code 27356 is used for the surgical removal of a lesion from the femur, often involving a graft procedure.
CPT code 27356 is used to describe the surgical procedure for the removal of a lesion from the femur, which is the thigh bone. This code indicates that the procedure may involve excising a tumor or abnormal tissue from the femur and may also include the use of a graft to repair the area after the lesion has been removed. This code is relevant for healthcare providers involved in orthopedic surgery and helps in accurately documenting and billing for the procedure performed.
When billing for the CPT code 27356, which pertains to the removal of a femur lesion or graft, 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: Use this modifier if the procedure is performed on both femurs during the same session.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session, indicating that the primary procedure is being billed along with additional procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed on a separate site or is distinct from other services provided on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier 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 applicable 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 should be used 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 indicates that the procedure was performed on the left femur specifically.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right femur specifically.
9. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is used when a patient has multiple encounters on the same date of service, which may include the same or different procedures.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 27356 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides detailed information on the allowable payment amounts for various CPT codes, including 27356. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement eligibility and processing claims for this CPT code.
It is essential for healthcare providers to consult the MPFS and their respective MAC guidelines to ensure compliance and accurate reimbursement for CPT code 27356.
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 27356 and ensure you are receiving the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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