CPT code 27652 is used for billing the repair or grafting of the Achilles tendon in healthcare services.
CPT code 27652 is used to describe the surgical procedure for repairing or grafting the Achilles tendon. This code indicates that a healthcare provider has performed a surgical intervention to address a tear or injury to the Achilles tendon, which is located at the back of the ankle and is crucial for walking and running. The procedure may involve suturing the tendon back together or using a graft to restore its function and integrity.
When billing for the CPT code 27652 (Repair/graft achilles tendon), the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both legs.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if the procedure is performed in conjunction with other surgical procedures during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician: This modifier should be used if the procedure is a staged procedure or if it is related to a previous procedure performed by the same physician.
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 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician: This modifier is relevant 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: This modifier is used if a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier RT - Right Side: Use this modifier to indicate that the procedure was performed on the right leg.
9. Modifier LT - Left Side: Use this modifier to indicate that the procedure was performed on the left leg.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier is applicable if the procedure is performed by a non-physician provider under the supervision of a physician.
It is essential to review the specific circumstances of the procedure to determine the appropriate modifiers to use, ensuring compliance with payer guidelines and accurate reimbursement.
The CPT code 27652 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates and guidelines for each CPT code, while the MAC can offer localized insights and any additional requirements or restrictions that may apply.
Always ensure to check the latest updates and guidelines to confirm the current reimbursement status for CPT code 27652.
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