CPT code 28043 is used to describe the excision of a foot or toe tumor that is less than 1.5 cm in size.
CPT code 28043 is used to describe the excision of a tumor located on the foot or toe that measures less than 1.5 centimeters in size. This procedure involves the surgical removal of the tumor along with some surrounding tissue to ensure complete excision and minimize the risk of recurrence.
When billing for CPT code 28043, 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 feet.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left foot.
5. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
6. Modifier 22 - Increased Procedural Services: This modifier may be applicable if the procedure required significantly more work than typically required.
7. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is appropriate if the patient requires a return to the operating room for a related procedure within the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used if a different procedure is performed by the same physician during the postoperative period.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is applicable if an unrelated E/M service is provided during the postoperative period.
Each of these modifiers serves to provide additional context for the procedure performed and can help ensure accurate billing and reimbursement.
The CPT code 28043 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to ensure that there are no local coverage determinations (LCDs) or specific billing guidelines that could affect reimbursement for CPT code 28043. Each MAC may have unique requirements or documentation standards that must be met to secure payment.
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 28043, you can ensure that every dollar is accounted for. Schedule a demo today to see how RevFind can help you maximize your reimbursements and streamline your financial processes.
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