CPT code 27364 is for the surgical removal of a tumor from the thigh or knee that is larger than 5 cm.
CPT code 27364 is used to describe a surgical procedure involving the resection, or removal, of a tumor located in the thigh or knee area that measures greater than 5 centimeters. This code indicates that the procedure is more extensive due to the size of the tumor, and it typically involves careful excision to ensure complete removal while preserving surrounding tissues as much as possible.
When billing for the CPT code 27364, which pertains to the resection of a thigh or knee tumor greater than 5 cm, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both the left and right sides of the body.
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 separately and is not considered to be part of another procedure performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the same procedure is performed more than once by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating Room: This modifier is applicable if the patient requires a return to the operating room for a related procedure within the global period of the original procedure.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier should be used if a procedure is performed that is unrelated to the original procedure during the global period.
7. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right side of the body.
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 applicable when a patient has multiple encounters on the same date of service, and it helps to differentiate the services provided.
It is essential to review the specific circumstances of the procedure and consult payer guidelines to determine the appropriate use of these modifiers.
The CPT code 27364 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any potential coverage limitations, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the relevant Medicare Administrative Contractor (MAC) for any regional variations or additional guidelines that may apply to the reimbursement of CPT code 27364.
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