CPT code 27358 is used for the removal of a lesion or fixation from the femur, a key procedure in orthopedic surgery.
CPT code 27358 is used to describe the surgical procedure for the removal of a lesion from the femur, which is the thigh bone. This code specifically indicates that the procedure involves not only excising the lesion but also addressing any fixation that may be present, ensuring that the area is properly treated and stabilized post-removal.
When billing for the CPT code 27358, which pertains to the removal of a femur lesion or fixation, several modifiers may be applicable depending on the specific circumstances of the procedure. Here 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 is applicable if multiple procedures are performed during the same session, including the removal of the femur lesion/fixation.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used when the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: If the procedure is repeated by the same physician on the same day, this modifier should be applied.
5. 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.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: If a patient requires a return to the operating room for a related procedure within the global period, this modifier should be used.
7. 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.
8. Modifier LT - Left Side: Use this modifier to indicate that the procedure was performed on the left femur.
9. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right femur.
10. Modifier 22 - Increased Procedural Services: If the procedure required significantly more work than typically required, this modifier can be used to indicate the increased complexity.
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 27358 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations (LCDs) or specific billing guidelines that may affect reimbursement for CPT code 27358.
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