CPT code 28055 is a medical billing code used to describe a neurectomy procedure performed on the foot.
CPT code 28055 is a procedure that involves the surgical removal of a nerve in the foot. This neurectomy is typically performed to alleviate pain or discomfort caused by nerve-related issues, such as neuromas or other nerve entrapments. The procedure aims to provide relief by interrupting the pain signals transmitted by the affected nerve.
When billing for CPT code 28055 (Neurectomy foot), 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 neurectomy is performed on both feet.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple procedures are performed during the same session, including the neurectomy.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used if the neurectomy is performed on a separate site or area that is distinct from other procedures performed on the same day.
4. Modifier LT - Left Side: Use this modifier if the neurectomy is performed on the left foot.
5. Modifier RT - Right Side: Use this modifier if the neurectomy is performed on the right foot.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the neurectomy is repeated on the same foot by the same physician.
7. Modifier 78 - Unplanned Return to the Operating Room: This modifier should be used if the patient requires a return to the operating room for a related procedure within the global period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is applicable if a different procedure unrelated to the neurectomy is performed by the same physician during the global period.
9. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required for a neurectomy.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is used if an evaluation and management service is provided on the same day as the neurectomy but is unrelated to the procedure.
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 28055 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services and procedures covered by Medicare, and it is updated annually to reflect changes in policy and reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT codes. Therefore, while CPT code 28055 is generally reimbursed by Medicare, healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding reimbursement rates and coverage criteria.
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