CPT code 28088 is used to describe the excision of a foot tendon sheath, detailing a specific surgical procedure for billing and documentation.
CPT code 28088 is used to describe the surgical procedure of excising or removing a tendon sheath in the foot. This procedure typically involves the removal of the sheath surrounding a tendon to alleviate issues such as inflammation, infection, or other conditions affecting the tendon. It is often performed to improve function and reduce pain in the affected area.
When billing for the CPT code 28088, which pertains to the excision of a foot tendon sheath, 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.
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 patient returned to the operating room for a related procedure during the postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
7. Modifier LT - Left Side
Specifies that the procedure was performed on the left foot.
8. Modifier RT - Right Side
Specifies that the procedure was performed on the right foot.
9. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services
Indicates that the service was performed by a non-physician practitioner.
10. Modifier 22 - Increased Procedural Services
Used when the work required to provide a service is substantially greater 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.
Determining whether CPT code 28088 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by your regional Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates.
To ascertain if CPT code 28088 is reimbursed, you should first check the MPFS database. This can be done through the Centers for Medicare & Medicaid Services (CMS) website, where you can search for the specific CPT code and review its status. Additionally, your regional MAC may have specific guidelines or policies that could affect reimbursement for this code. MACs are responsible for processing Medicare claims and can provide more localized information regarding coverage and payment.
In summary, to determine if CPT code 28088 is reimbursed by Medicare, consult the MPFS and verify any additional guidelines from your regional MAC.
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 28088, you can ensure that every dollar is accounted for. Schedule a demo today to see how RevFind can help you identify and rectify underpayments effectively.
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