CPT code 28046 is used to describe the surgical removal of a foot or toe tumor that is less than 3 cm in size.
CPT code 28046 is used to describe the surgical procedure for the resection of a tumor located in the foot or toe that measures less than 3 centimeters in size. This code indicates that the healthcare provider has performed a surgical excision to remove the tumor, which may be necessary for both diagnostic and therapeutic purposes.
When billing for CPT code 28046 (Resect foot/toe tumor < 3 cm), 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 or toes.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if multiple surgical procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: Use this modifier when the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the procedure is repeated on the same day by the same physician.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the 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: This modifier is applicable if a different procedure is performed by the same physician during the postoperative period.
7. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left foot or toe.
8. Modifier RT - Right Side: This modifier should be used if the procedure is performed on the right foot or toe.
9. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is applicable if an unrelated evaluation and management service is provided during the postoperative period.
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 28046 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates and guidelines for services covered under Medicare Part B.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) have the authority to make local coverage determinations. Therefore, it is advisable to consult the MPFS and your respective MAC to confirm the reimbursement specifics for CPT code 28046.
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