CPT code 27519 is used to describe the treatment of a thigh fracture involving the growth plate, ensuring accurate billing and documentation.
CPT code 27519 is used to describe the surgical procedure for treating a fracture of the femur (thigh bone) that involves the growth plate. This code specifically indicates that the procedure addresses a fracture in the area where the bone grows, which is critical for proper development and alignment in pediatric patients.
When billing for CPT code 27519, which pertains to the treatment of a thigh fracture involving the growth plate, 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 sides of the body.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 52 - Reduced Services
Used when the service provided is less than what is typically required for the procedure.
4. Modifier 53 - Discontinued Procedure
Indicates that the procedure was terminated due to extenuating circumstances.
5. Modifier 76 - Repeat Procedure by Same Physician
Used when the same procedure is performed again by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician
Indicates that the same procedure was performed again by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Used when a patient requires an unplanned 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
Indicates that a procedure unrelated to the original procedure was performed during the postoperative period.
9. Modifier LT - Left Side
Used to specify that the procedure was performed on the left side of the body.
10. Modifier RT - Right Side
Used to specify that the procedure was performed on the right side of the body.
11. Modifier 22 - Increased Procedural Services
Indicates that the work required to provide the service was substantially greater than typically required.
12. Modifier 59 - Distinct Procedural Service
Used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
When using these modifiers, it is essential to ensure that they accurately reflect the services provided and comply with payer guidelines to avoid claim denials.
The CPT code 27519 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to confirm the specific reimbursement rate and any additional requirements for CPT code 27519.
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 27519, RevFind identifies discrepancies that could impact your bottom line. Schedule a demo today to see how RevFind can help you recover lost revenue and optimize your financial performance.
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