CPT code 274 is a medical billing code used to describe specific procedures related to the knee, aiding in accurate healthcare billing and documentation.
CPT code 274 is used to describe a surgical procedure involving the knee, specifically a total knee arthroplasty, which is the replacement of the knee joint with an artificial implant. This procedure is typically performed to relieve pain and restore function in patients suffering from severe knee arthritis or other degenerative conditions.
When billing for CPT code 274, the following modifiers may be applicable, depending on the specific circumstances of the service provided. Here is a list of potential modifiers and their reasons for use:
1. Modifier 50 - Bilateral Procedure: Use this modifier when the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same session by the same provider.
3. Modifier 52 - Reduced Services: This modifier indicates that the service provided was reduced in complexity or time compared to the standard procedure.
4. Modifier 53 - Discontinued Procedure: Use this modifier when a procedure is started but then discontinued due to extenuating circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is performed again by the same provider on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier indicates that the same procedure was performed again by a different provider.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier when a patient requires a return to the operating room for a related procedure within the global period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable when a procedure is performed that is unrelated to the original procedure during the postoperative period.
9. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier indicates that an evaluation and management service is unrelated to the procedure performed during the postoperative period.
It is essential to review the specific circumstances of the service provided to determine the appropriate modifier(s) to use with CPT code 274. Proper use of modifiers can help ensure accurate billing and reimbursement.
The CPT code 274 is not reimbursed by Medicare. To determine if a specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and can offer guidance on the reimbursement status of specific CPT codes. For the most accurate and up-to-date information, it is advisable to consult both the MPFS and your respective MAC.
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 274, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you maximize your revenue and minimize losses.
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