CPT code 28045 is for excising a deep tumor on the foot or toe that is less than 1.5 cm in size.
CPT code 28045 is used to describe a surgical procedure involving the excision of a tumor located in the foot or toe that is deep and measures less than 1.5 centimeters in size. This code indicates that the procedure is specifically for removing a tumor that is not just on the surface but has penetrated deeper tissues, which may require more careful surgical techniques.
When billing for CPT code 28045, which pertains to excision of a foot or toe tumor less than 1.5 cm deep, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both feet or toes.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 59 - Distinct Procedural Service
Used to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
Indicates that the same procedure was performed again by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Used when a patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Indicates that a procedure unrelated to the original procedure was performed during the postoperative period.
7. Modifier LT - Left Side
Used to specify that the procedure was performed on the left foot or toe.
8. Modifier RT - Right Side
Used to specify that the procedure was performed on the right foot or toe.
9. Modifier 22 - Increased Procedural Services
Indicates that the procedure was more complex than usual, warranting additional reimbursement.
10. Modifier 27 - Multiple Encounters on the Same Date
Used when a patient has multiple encounters on the same date of service.
These modifiers help provide additional context for the procedure performed and ensure accurate billing and reimbursement in the healthcare revenue cycle management process.
The CPT code 28045 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should refer to the MPFS.
Additionally, it is important to consult with the local Medicare Administrative Contractor (MAC) for any region-specific policies or additional documentation requirements that may affect reimbursement for CPT code 28045.
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 28045, RevFind identifies discrepancies that could impact your bottom line. Schedule a demo today to see how our solution can help you recover lost revenue and improve your financial performance.
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