CPT code 27396 is for the surgical procedure involving the transplant of a thigh tendon, used to restore function or repair injuries.
CPT code 27396 is for the surgical procedure involving the transplantation of a tendon from the thigh. This procedure is typically performed to repair or reconstruct damaged tendons in the knee or other areas, facilitating improved function and mobility for the patient.
When billing for the CPT code 27396, which pertains to the transplant of a thigh tendon, 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 sides of the body.
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 or Other Qualified Health Care Professional
Used when a procedure is planned or anticipated to be performed in a staged manner.
4. Modifier 59 - Distinct Procedural Service
Indicates that a procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the same procedure is repeated by the same provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
Indicates a return to the operating room for a related procedure within the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier LT - Left Side
Indicates that the procedure was performed on the left side of the body.
9. Modifier RT - Right Side
Indicates that the procedure was performed on the right side of the body.
10. Modifier 22 - Increased Procedural Services
Used when the work required to provide a service is substantially greater 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 27396. Proper modifier usage can help ensure accurate reimbursement and compliance with payer requirements.
The CPT code 27396 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 payment rates for services covered under Medicare Part B.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your geographic area to obtain precise information on the reimbursement rate and any specific billing requirements for CPT code 27396.
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 and by individual payer. For instance, with CPT code 27396, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
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