CPT code 28111 is for the partial removal of a metatarsal bone, commonly performed to treat foot conditions.
CPT code 28111 is the code used to describe the surgical procedure involving the partial removal of a metatarsal bone in the foot. This procedure is typically performed to alleviate pain or correct deformities associated with conditions affecting the metatarsal, such as bunions or other structural abnormalities.
When billing for the CPT code 28111, which pertains to the partial removal of a metatarsal, 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.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed separately from other procedures on the same day, indicating that it is not part of a bundled service.
4. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left foot.
5. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
6. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
8. 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.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is used if a procedure is performed that is unrelated to the original procedure during the global period.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is applicable for an unrelated E/M service provided by the same physician during the global period.
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 28111 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the allowable payment amounts for services covered under Medicare Part B.
Additionally, the reimbursement for CPT code 28111 may vary depending on the local policies and guidelines set by the Medicare Administrative Contractor (MAC) for the region where the service is provided. It is essential to consult the MPFS and the relevant MAC to determine the exact reimbursement details and any specific requirements or limitations that may apply.
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