CPT code 27485 is a surgical procedure used to stop leg growth, often performed to address limb length discrepancies in patients.
CPT code 27485 is a surgical procedure aimed at stopping the growth of the leg, typically performed in cases where there is a significant discrepancy in leg length or when growth needs to be controlled for medical reasons. This procedure may involve techniques such as epiphysiodesis, where the growth plate is surgically altered to halt further growth in the affected leg.
When billing for the CPT code 27485, 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 legs.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple surgical procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: Use this modifier if the procedure is part of a staged treatment plan 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 performed separately and is not considered part of another procedure.
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 Room: This modifier should be used if the patient requires an unplanned return to the operating room for a related procedure within the global period.
7. Modifier 79 - Unrelated Procedure by Same Physician: This modifier is applicable if a different procedure is performed by the same physician during the global period that is unrelated to the original procedure.
8. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is appropriate if an evaluation and management service is provided during the global period that is unrelated to the surgical procedure.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: This modifier can be used if multiple evaluation and management services are provided on the same day in an outpatient setting.
It is essential to select the appropriate modifier(s) based on the specific circumstances surrounding the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 27485 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS, which provides detailed information on payment rates and guidelines for various CPT codes.
Additionally, it is essential to verify with the local Medicare Administrative Contractor (MAC) as they may have specific coverage policies or documentation requirements that could affect reimbursement. Each MAC can provide region-specific guidance and ensure that the claim meets all necessary criteria for Medicare 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. With RevFind, you can identify discrepancies for CPT code 27485, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline 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
