CPT code 27395 is for the surgical lengthening of thigh tendons, used to describe a specific medical procedure in billing and documentation.
CPT code 27395 is a procedure that involves the surgical lengthening of the tendons in the thigh. This procedure is typically performed to address conditions that result in tightness or shortening of the tendons, which can affect mobility and function. By lengthening the tendons, the surgery aims to improve the range of motion and alleviate discomfort for the patient.
When billing for the CPT code 27395 (Lengthening of thigh tendons), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both thighs.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician
Used when the procedure is part of a staged treatment plan or a subsequent procedure related to the initial procedure.
4. Modifier 59 - Distinct Procedural Service
Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician
Used when the same procedure is performed more than once by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure
Indicates that a return to the operating room was necessary due to complications or related issues from the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right thigh.
9. Modifier LT - Left Side
Indicates that the procedure was performed on the left thigh.
10. Modifier 22 - Increased Procedural Services
Used when the procedure required significantly more work than typically required.
It is essential for healthcare providers to assess the specific circumstances of the procedure to determine the appropriate modifiers to use when billing for CPT code 27395. Proper use of modifiers can help ensure accurate reimbursement and compliance with payer requirements.
CPT code 27395 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and the corresponding payment rates. To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS directly.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on the reimbursement for CPT code 27395. Providers should check with their respective MAC to ensure compliance with local coverage determinations and any other pertinent guidelines.
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