CPT code 27635 is used to describe the procedure for removing a bone lesion from the lower leg.
CPT code 27635 is used to describe the surgical procedure for the removal of a bone lesion located in the lower leg. This code specifically indicates that the lesion, which may be benign or malignant, is being excised from the bone structure in the lower leg region, typically involving the tibia or fibula. The procedure aims to alleviate symptoms, prevent further complications, or facilitate further treatment options.
When billing for the CPT code 27635, there are several modifiers that 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.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed separately from other services on the same day, indicating that it is not part of a bundled service.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating Room: This modifier is applicable if the patient requires an unplanned 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: This modifier should be used 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.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right leg.
9. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is used when a patient has multiple encounters on the same date of service.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements.
The CPT code 27635 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 specific guidelines and fee schedules that apply to their jurisdictions. Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date reimbursement information for CPT code 27635.
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