CPT code 27535 is used to describe the treatment of a knee fracture, detailing the specific procedure performed by healthcare providers.
CPT code 27535 is used to describe the surgical procedure for the treatment of a knee fracture. This code specifically refers to the open treatment of a femoral condyle fracture, which involves the surgical fixation of the fractured bone in the knee area to restore stability and function. The procedure may include the use of hardware such as plates or screws to secure the bone fragments in place, ensuring proper healing and alignment.
When billing for CPT code 27535, which pertains to the treatment of a knee fracture, 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 knees during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if the procedure is performed in conjunction with other procedures on the same day.
3. Modifier 58 - Staged or Related Procedure: This modifier should be used if the procedure is a staged procedure or if it is related to a previous procedure performed during the postoperative period.
4. Modifier 59 - Distinct Procedural Service: This modifier is applicable when the procedure is performed separately from other procedures on the same day, indicating that it is distinct or independent.
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 77 - Repeat Procedure by Another Physician: This modifier is used when the procedure is repeated by a different physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is appropriate if the patient requires a return to the operating room for a related procedure within the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
9. Modifier 90 - Reference (Outside) Laboratory: This modifier is used if the procedure involves sending specimens to an outside laboratory for analysis.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is applicable if the procedure involves a repeat laboratory test on the same day.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27535 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and consult with your Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. Additionally, MACs can offer region-specific guidance and any potential variations in coverage or payment policies.
Therefore, while CPT code 27535 is generally reimbursed, always confirm with the MPFS and your MAC to ensure compliance and accurate billing.
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 27535 and ensure you are receiving the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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