CPT code 27658 is for the surgical repair of a tendon in the leg, detailing the specific procedure performed.
CPT code 27658 is used to describe the surgical procedure for the repair of a tendon in the leg. This code specifically refers to the repair of each tendon, indicating that if multiple tendons are repaired during the same surgical session, each would be billed separately using this code. This procedure typically involves suturing or reconnecting the tendon to restore its function and integrity, often following an injury or tear.
When billing for CPT code 27658 (Repair of leg tendon each), 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: This modifier is used when the procedure is performed on both legs. It indicates that the repair was done on both sides, which may affect reimbursement.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same session. It indicates that the repair of the tendon is one of several procedures performed.
3. Modifier 58 - Staged or Related Procedure: This modifier is used when the repair is part of a staged procedure or a procedure that is related to a previous procedure performed on the same site.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is important to use this modifier when the repair is not part of a bundled service.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is performed again by the same 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: This modifier is used when a procedure is performed that is unrelated to the original procedure during the global period.
8. Modifier RT - Right Side: This modifier is used to specify that the procedure was performed on the right leg.
9. Modifier LT - Left Side: This modifier is used to specify that the procedure was performed on the left leg.
Using the appropriate modifiers is crucial for accurate billing and reimbursement, as they provide additional context for the services rendered. Always ensure that the modifiers used align with the specific circumstances of the procedure performed.
CPT code 27658 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 by Medicare.
Additionally, it is essential to consult with your regional Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide localized information on coverage policies and reimbursement rates for CPT code 27658. They can also offer guidance on any documentation requirements or additional criteria that must be met for successful 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 codes like 27658, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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