CPT code 27365 is used to describe the surgical procedure for resecting a tumor from the femur or knee area.
CPT code 27365 is used to describe the surgical procedure of resecting a tumor located in the femur or knee area. This code indicates that a healthcare provider has performed an operation to remove a tumor from the bone or surrounding tissues in the thigh or knee region, which may be necessary for treatment of conditions such as bone cancer or other tumors affecting the skeletal system.
When billing for the CPT code 27365 (Resect femur/knee tumor), 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 knees or femurs during the same session.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if multiple procedures are performed during the same surgical session, including the resection of the femur/knee tumor.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed separately from other procedures on the same day, indicating that it is distinct or independent.
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 postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier should be used if a different procedure is performed by the same physician during the postoperative period that is unrelated to the initial procedure.
7. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
8. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is relevant if an evaluation and management service is provided during the postoperative period that is unrelated to the surgical procedure.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and appropriate reimbursement for healthcare providers.
The CPT code 27365 is subject to reimbursement by Medicare, but its eligibility and the amount reimbursed are determined by the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the specific reimbursement details can vary based on the region, as they are managed by Medicare Administrative Contractors (MACs). These contractors are responsible for processing Medicare claims and ensuring compliance with Medicare policies.
Therefore, to determine the exact reimbursement for CPT code 27365, healthcare providers should consult the MPFS and their respective MAC.
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