CPT code 28047 is used to describe the surgical procedure for resecting a foot or toe tumor larger than 3 cm.
CPT code 28047 is used to describe the surgical procedure of resecting a tumor located in the foot or toe that measures greater than 3 centimeters. This code indicates that the procedure involves the removal of the tumor along with some surrounding tissue to ensure complete excision, which is crucial for preventing recurrence and addressing any potential malignancy.
When billing for the CPT code 28047 (Resect foot/toe tumor 3 cm/>), 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 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
Applied when the same procedure is performed more than once by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Indicates that a return to the operating room was necessary due to complications from the initial procedure.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a different procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier LT - Left Side
Indicates that the procedure was performed on the left foot or toe.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot or toe.
9. Modifier 22 - Increased Procedural Services
Used when the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date
Indicates that multiple encounters occurred on the same date of service.
It is essential for healthcare providers to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 28047 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) in your region. Each MAC may have specific guidelines and coverage determinations that affect whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult both the MPFS and your local MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 28047.
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 RevFind, you can identify discrepancies for CPT code 28047 and ensure you are receiving the correct reimbursements. Schedule a demo today to see how our solution can optimize your revenue recovery process.
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