CPT code 27468 is a medical billing code used for procedures that shorten or lengthen the thighs in orthopedic surgery.
CPT code 27468 is used to describe a surgical procedure that involves either shortening or lengthening the thigh bone (femur). This procedure is typically performed to correct deformities, improve function, or address issues related to leg length discrepancies. It may be indicated for patients with conditions such as congenital deformities, trauma, or certain orthopedic disorders.
When billing for CPT code 27468, which pertains to the shortening or lengthening of thighs, several modifiers 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 thighs during the same session.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session, which may affect reimbursement.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
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 or Other Qualified Health Care Professional
Used when the same procedure is performed again by the same provider on the same day.
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
Indicates an unplanned return to the operating room for a related procedure.
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 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 requires significantly more work than typically required, justifying additional reimbursement.
It is essential for healthcare providers to assess the specific circumstances of the procedure to determine the appropriate modifiers to use, ensuring accurate billing and compliance with payer requirements.
CPT code 27468 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, it is essential to verify the specific details with your Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 27468. Always ensure that the service meets the medical necessity criteria and documentation requirements set forth by Medicare to facilitate smooth reimbursement.
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 27468, 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.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
