CPT code 27455 is a medical billing code used for the realignment of the knee, helping healthcare providers accurately document and bill for the procedure.
CPT code 27455 is the procedure for realigning the knee joint. This surgical intervention is typically performed to correct deformities or misalignments in the knee, often due to conditions such as osteoarthritis or injury. The goal of this procedure is to restore proper alignment, improve function, and alleviate pain in the knee, ultimately enhancing the patient's mobility and quality of life.
When billing for CPT code 27455 (Realignment of 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:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both knees during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple surgical procedures are performed during the same session, including the realignment of the knee.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used if the realignment is part of a staged procedure or if it is a subsequent procedure related to the initial surgery.
4. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated 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: This modifier is relevant if the patient requires an unplanned return to the operating room for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if a completely unrelated procedure is performed during the postoperative period of the initial surgery.
8. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right knee.
9. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left knee.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when a non-physician provider assists in the surgical procedure.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27455 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 and their corresponding reimbursement rates. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 27455.
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 CPT code 27455 and ensure you are receiving the correct reimbursement. Schedule a demo today to see how RevFind can help you maximize your revenue.
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