CPT code 28035 is for the surgical procedure that relieves pressure on the tibial nerve, often to alleviate pain or restore function.
CPT code 28035 is a procedure that involves the surgical decompression of the tibial nerve. This typically means that the surgeon is relieving pressure on the tibial nerve, which runs down the leg and can be affected by conditions such as nerve entrapment or injury. The goal of this procedure is to alleviate pain, restore function, and improve the overall quality of life for the patient by ensuring that the nerve can function properly without obstruction.
When billing for the CPT code 28035, which pertains to the decompression of the tibial nerve, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service
Used when a subsequent procedure is planned or anticipated during the postoperative period.
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 by Same Physician
Used when the same procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Indicates that a patient returned to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right side of the body.
9. Modifier LT - Left Side
Indicates that the procedure was performed on the left side of the body.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services
Used when the service is performed by a non-physician provider.
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.
CPT code 28035 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. However, it is essential to verify the coverage and reimbursement details with your local Medicare Administrative Contractor (MAC), as they administer Medicare claims and can provide region-specific information. Each MAC may have unique guidelines and policies that could affect the reimbursement for CPT code 28035.
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 the ability to identify discrepancies for specific codes like 28035, you can ensure that your practice is receiving the full reimbursement it deserves. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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