CPT code 27472 is for the surgical repair or grafting of the thigh, used for billing and documentation in healthcare services.
CPT code 27472 is for the surgical procedure involving the repair or grafting of the thigh. This code is used to describe interventions aimed at restoring the function or structure of the thigh, typically following an injury or to address a specific medical condition. The procedure may involve the use of grafts to support healing or to replace damaged tissue in the thigh area.
When billing for CPT code 27472, 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 thighs.
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
Applied when the procedure is a staged procedure or a procedure related to a previous one performed by the same physician.
4. Modifier 59 - Distinct Procedural Service
Used to indicate 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
Indicates that the same procedure was performed again 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
Used when a patient returns for a related procedure due to complications from the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Indicates that a procedure unrelated to the original procedure was performed during the postoperative period.
8. Modifier RT - Right Side
Used to specify that the procedure was performed on the right thigh.
9. Modifier LT - Left Side
Used to specify that the procedure was performed on the left thigh.
10. Modifier 22 - Increased Procedural Services
Indicates that the procedure was more complex than usual, warranting additional reimbursement.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements.
CPT code 27472 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and any applicable modifiers that may affect reimbursement.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 27472. It is essential to consult the relevant MAC for your region to understand any specific guidelines or requirements that may impact the reimbursement process for this code.
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 codes like 27472, ensuring you capture every dollar owed to your practice. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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
