CPT code 27487 is for the surgical procedure to revise or replace a knee joint, ensuring accurate billing and documentation in healthcare.
CPT code 27487 is used to describe the surgical procedure of revising or replacing a knee joint. This code specifically indicates that a healthcare provider is performing a revision of a previously implanted knee prosthesis or replacing it entirely due to complications such as wear, loosening, or infection. This procedure is typically necessary to restore function and alleviate pain in patients who have undergone prior knee surgeries.
When billing for the CPT code 27487, which pertains to the revision or replacement of a knee joint, 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 knees 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 a staged procedure or a procedure related to a previous procedure performed by the same provider.
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 repeated on the same day by the same provider.
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 During the Postoperative Period
Indicates that a return to the operating room was necessary due to complications or issues arising from the initial 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 unrelated to the original procedure is performed during the postoperative period.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right knee.
9. Modifier LT - Left Side
Indicates that the procedure was performed on the left knee.
10. Modifier 22 - Increased Procedural Services
Used when the procedure performed is significantly more complex or requires more time than usual.
It is essential for healthcare providers to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
CPT code 27487 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 27487. However, the final determination of reimbursement is often influenced by the local policies set by the Medicare Administrative Contractor (MAC) for your region. Each MAC has the authority to establish coverage guidelines and payment amounts, which can result in variations in reimbursement rates and requirements. Therefore, it is essential to consult the MPFS and your specific MAC's guidelines to understand the exact reimbursement details for CPT code 27487.
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, including specific codes like 27487. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your reimbursement 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
