CPT code 27645 is used to describe the surgical procedure for resecting a tumor from the tibia, or shinbone, in patients.
CPT code 27645 is used to describe the surgical procedure for resecting a tumor located in the tibia, which is the larger bone in the lower leg. This code indicates that the healthcare provider has performed a surgical excision of the tumor, which may involve removing part of the tibia to ensure complete removal of the tumor and to promote healing. This procedure is typically indicated for patients with bone tumors that require surgical intervention.
When billing for the CPT code 27645, which pertains to the resection of a tibia tumor, 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.
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 to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated by a different physician on the same day.
6. 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.
7. 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.
8. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
9. Modifier 26 - Professional Component: Use this modifier if billing for the professional component of the service separately from the technical component.
10. Modifier TC - Technical Component: This modifier is applicable if billing for the technical component of the service separately from the professional component.
It is essential to evaluate the specific circumstances of the procedure to determine which modifiers are appropriate for accurate billing and compliance with payer requirements.
CPT code 27645 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 and their respective reimbursement rates.
Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm the reimbursement status and any specific billing requirements or guidelines that may apply to CPT code 27645. The MACs are responsible for processing Medicare claims and can provide the most accurate and up-to-date information regarding coverage and reimbursement.
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 specific CPT code 27645, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how our solution can streamline your processes and improve your bottom line.
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