CPT code 27412 is a medical billing code for the procedure of implanting autochondrocytes in the knee to treat cartilage damage.
CPT code 27412 is a procedure that involves the implantation of autologous chondrocytes into the knee joint. This technique is used to repair damaged cartilage by utilizing the patient's own cartilage cells, which are cultured and then re-implanted to promote healing and restore function in the knee.
When billing for CPT code 27412 (Autochondrocyte implant knee), several modifiers may be applicable depending on the specific circumstances of the procedure. Here 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 knees.
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 the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
Indicates that the same procedure was repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician
Used when the same procedure is performed by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Indicates 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
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 knee.
9. Modifier RT - Right Side
Indicates that the procedure was performed on the right knee.
10. Modifier 22 - Increased Procedural Services
Used when the service provided is significantly greater than what is typically required for the procedure.
It is essential for healthcare providers to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 27412 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, along with the corresponding reimbursement rates. However, the final determination of reimbursement for CPT code 27412 may also depend on the guidelines and policies set forth by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and ensuring that services meet the necessary criteria for coverage. Therefore, it is essential to consult both the MPFS and your regional MAC to confirm the reimbursement status and any additional requirements for CPT code 27412.
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