CPT code 27381 is for the surgical repair or grafting of the kneecap tendon, detailing the specific procedure performed.
CPT code 27381 is for the surgical procedure involving the repair or grafting of the kneecap tendon. This code is used when a healthcare provider performs a surgical intervention to fix or reconstruct the tendon associated with the kneecap, which may be necessary due to injury or degeneration. The procedure aims to restore function and stability to the knee joint.
When billing for the CPT code 27381 (Repair/graft 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 procedure is a staged or related procedure that is performed during the postoperative period of a previous procedure.
4. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that 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 during the postoperative period.
7. Modifier 79 - Unrelated Procedure by Same Physician: This modifier is appropriate if a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier RT - Right Side: Use this modifier to specify 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 AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist: This modifier can be used if the procedure is performed by a non-physician practitioner.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27381 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the associated payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and determining coverage specifics within their jurisdictions. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement details for CPT code 27381.
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