CPT code 28011 is for the surgical incision of toe tendons, used to describe a specific medical procedure in billing and documentation.
CPT code 28011 is for the surgical procedure involving the incision of tendons in the toe. This code is used when a healthcare provider performs an operation to access and treat issues related to the tendons in the toe, which may include conditions such as tendonitis or other injuries that require surgical intervention.
When billing for the CPT code 28011 (Incision of toe tendons), 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
Used when the procedure is performed on both toes.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
Used when the procedure is part of a staged treatment plan or a subsequent procedure related to the initial procedure.
4. Modifier 59 - Distinct Procedural Service
Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the same procedure is performed again by the same provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure
Indicates that a return to the operating room was necessary due to complications or related issues from the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Used when a procedure unrelated to the original procedure is performed during the postoperative period.
8. Modifier LT - Left Side
Indicates that the procedure was performed on the left toe.
9. Modifier RT - Right Side
Indicates that the procedure was performed on the right toe.
10. Modifier 22 - Increased Procedural Services
Used when the work required to provide the service is substantially greater than typically required.
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 28011 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.
Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 28011.
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. For instance, with CPT code 28011, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you maximize your revenue and minimize losses.
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