CPT code 28104 is for the removal of a foot lesion, detailing the specific procedure for accurate billing and documentation in healthcare.
CPT code 28104 is for the surgical removal of a lesion located on the foot. This procedure typically involves excising a growth or abnormal tissue from the foot, which may be necessary for diagnostic purposes or to alleviate discomfort. The code specifically indicates that the removal is performed on the foot, distinguishing it from similar procedures on other parts of the body.
When billing for the CPT code 28104, which pertains to the removal of a foot lesion, 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.
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.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot.
9. Modifier 22 - Increased Procedural Services
Used when 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
Indicates that an unrelated evaluation and management service was provided during the postoperative period.
These modifiers help clarify the circumstances surrounding the procedure and ensure accurate billing and reimbursement. It is essential for healthcare providers to select the appropriate modifiers based on the specific details of the case to avoid claim denials and ensure compliance with coding guidelines.
The CPT code 28104 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, it is crucial to consult your regional Medicare Administrative Contractor (MAC) for any local coverage determinations (LCDs) or specific billing guidelines that may affect reimbursement for CPT code 28104. Each MAC may have unique policies that influence how this code is processed and reimbursed.
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