CPT code 28086 is used to describe the surgical procedure for excising a foot tendon sheath, helping to standardize billing and documentation.
CPT code 28086 is used to describe the surgical procedure of excising or removing a tendon sheath in the foot. This procedure typically involves the removal of a portion of the sheath surrounding a tendon, which may be necessary due to conditions such as inflammation, infection, or other pathologies affecting the tendon. The goal of this procedure is to alleviate pain and restore function in the affected area of the foot.
When billing for CPT code 28086, which pertains to the excision of a foot tendon sheath, 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 during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if the excision is performed in conjunction with other surgical procedures on the same day.
3. Modifier 58 - Staged or Related Procedure: Use this modifier if the excision is part of a staged procedure or if it is a subsequent procedure related to an earlier surgery.
4. Modifier 59 - Distinct Procedural Service: This modifier should be used when the excision is performed on a separate site or distinct from other procedures performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate if the excision is repeated on the same foot by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period.
7. Modifier 79 - Unrelated Procedure by Same Physician: This modifier is applicable if a different procedure is performed by the same physician during the global period of the original procedure.
8. Modifier RT - Right Side: Use this modifier to indicate that the procedure was performed on the right foot.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
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 28086 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding 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 28086 is generally reimbursed by Medicare, healthcare providers should consult the MPFS and their respective MAC to confirm the exact reimbursement rates and any specific coverage criteria.
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 specific codes like 28086, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your revenue processes and improve your bottom line.
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