CPT code 27380 is for the surgical repair of a tendon in the kneecap, helping to restore function and alleviate pain.
CPT code 27380 is the procedure code used for the surgical repair of a tendon associated with the kneecap (patella). This procedure typically involves suturing or reconstructing the tendon to restore its function and stability, often following an injury or tear. It is essential for healthcare providers to accurately document this procedure to ensure proper billing and reimbursement.
When billing for the CPT code 27380 (Repair of kneecap tendon), 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.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier is appropriate if the repair is part of a staged procedure or if it is a subsequent procedure related to the initial surgery.
4. Modifier 59 - Distinct Procedural Service: Use this modifier when the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating Room: This modifier should be used if the patient requires a return to the operating room for a related procedure within the global period.
7. Modifier 79 - Unrelated Procedure by Same Physician: This modifier is appropriate if a procedure unrelated to the original surgery is performed by the same physician during the global period.
8. Modifier RT - Right Side: Use this modifier to indicate that the procedure was performed on the right knee.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left knee.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27380 is reimbursed by Medicare, but it is essential to verify its specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect the reimbursement for CPT code 27380. Each MAC may have unique policies or requirements that could influence the reimbursement process.
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, including specific codes like 27380. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue.
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