CPT code 27828 is used to describe the treatment of a lower leg fracture, detailing the specific procedure performed by healthcare providers.
CPT code 27828 is used to describe the surgical treatment of a lower leg fracture, specifically involving the tibia and fibula. This code indicates that the procedure includes the stabilization of the fracture, which may involve the use of internal fixation devices such as plates or screws, or external fixation methods. It is typically utilized when the fracture requires surgical intervention to ensure proper alignment and healing.
When billing for CPT code 27828, which pertains to the treatment of a lower leg fracture, 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 lower legs.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used if a subsequent procedure is planned or anticipated during the postoperative period.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated on the same leg by the same physician.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if an unplanned return to the operating room is necessary for a related procedure.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is relevant if a completely unrelated procedure is performed during the postoperative period.
7. Modifier LT - Left Side: This modifier should be used if the procedure is performed on the left leg.
8. Modifier RT - Right Side: This modifier is applicable if the procedure is performed on the right leg.
9. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure requires significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is appropriate if multiple encounters occur on the same day for the same patient.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 27828 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and practice.
Additionally, reimbursement for CPT code 27828 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to obtain precise information on the reimbursement status and any specific requirements or limitations that may apply.
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 27828, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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
