CPT code 27397 is for the surgical procedure involving the transplantation of thigh tendons in patients.
CPT code 27397 is for the surgical procedure involving the transplantation of tendons in the thigh. This code is used to document and bill for the specific surgical intervention where tendons are moved from one location to another within the thigh area, typically to restore function or repair damage.
When billing for CPT code 27397, there are several modifiers that may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with this code, along with the reasons for their use:
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 59 - Distinct Procedural Service
Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
Applied when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
Indicates that the same procedure was performed by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Used when a patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Indicates that a procedure performed during the postoperative period is unrelated to the original procedure.
8. Modifier 22 - Increased Procedural Services
Used when the work required to provide a service is substantially greater than typically required.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
Indicates that an evaluation and management service was provided during the postoperative period that is unrelated to the original procedure.
10. Modifier 27 - Multiple Encounters on the Same Date
Used when a patient has multiple encounters on the same date of service.
It is essential for healthcare providers to carefully assess the specific circumstances of the procedure to determine the appropriate modifiers to use with CPT code 27397, ensuring accurate billing and compliance with payer requirements.
The CPT code 27397 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates.
Additionally, it is advisable to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect reimbursement for CPT code 27397. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and billing requirements.
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. With RevFind, you can identify discrepancies for specific CPT code 27397, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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