CPT code 27634 is used for excising a tumor from the leg or ankle that is larger than 5 cm.
CPT code 27634 is used to describe the excision of a tumor located in the leg or ankle region, specifically when the tumor is larger than 5 centimeters. This procedure involves the surgical removal of the tumor along with any surrounding tissue that may be affected, ensuring complete excision for both diagnostic and therapeutic purposes.
When billing for CPT code 27634, which pertains to excision of a leg or ankle tumor greater than 5 cm, 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 or ankles.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: Use this modifier when the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the procedure is repeated by the same physician on the same day.
5. 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 global period.
6. 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 of the original procedure.
7. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left leg or ankle.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right leg or ankle.
9. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is applicable if the patient has multiple encounters on the same day that are unrelated.
It is essential to evaluate the specific circumstances of the procedure to determine which modifiers are appropriate for accurate billing and compliance.
The CPT code 27634 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm coverage and any regional variations in reimbursement policies. The MAC is responsible for processing Medicare claims and can provide specific guidance on the reimbursement status of CPT code 27634 in your area.
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