CPT code 27638 is used for the removal or grafting of a leg bone lesion in medical billing and coding.
CPT code 27638 is used to describe the surgical procedure for the removal or grafting of a lesion located in the leg bone. This code indicates that a healthcare provider is performing an intervention to either excise a problematic area or to repair the bone using grafting techniques, which may involve the use of bone from another site or a synthetic material. This procedure is typically indicated for conditions such as tumors, infections, or other abnormalities affecting the leg bone.
When billing for the CPT code 27638, 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 procedures on the same day.
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/Procedure Room: This modifier is applicable 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: This modifier should be used if a different procedure is performed by the same physician during the postoperative period.
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: This modifier may 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 when the patient has multiple encounters on the same date of service.
Each of these modifiers serves a specific purpose and helps to provide additional context for the services rendered, ensuring accurate billing and reimbursement.
CPT code 27638 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this particular CPT code is covered and the reimbursement rate, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is essential to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 27638.
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 27638 and ensure you are receiving the payments you deserve. Schedule a demo today to see how our solution can optimize your financial performance.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
