CPT code 28112 is for the partial removal of a metatarsal bone, typically performed to treat foot conditions.
CPT code 28112 is used to describe the surgical procedure involving the partial removal of a metatarsal bone in the foot. This procedure may be performed to alleviate pain or correct deformities associated with conditions such as bunions or other foot disorders. The code specifically indicates that only a portion of the metatarsal is being removed, rather than the entire bone.
When billing for the CPT code 28112, 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 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional: This modifier is appropriate if the procedure is part of a staged treatment plan.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: Use this modifier if an unplanned return to the operating room is necessary for a related procedure.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: This modifier is applicable if a different procedure is performed during the postoperative period that is unrelated to the initial procedure.
6. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
7. Modifier 26 - Professional Component: If the procedure has a professional component that is billed separately, this modifier should be used.
8. Modifier TC - Technical Component: This modifier is used when billing for the technical component of the procedure separately.
9. Modifier KX - Requirements Specified in the Medical Policy Have Been Met: This modifier indicates that specific criteria have been met for coverage.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: If applicable, this modifier is used when a test is repeated on the same day.
It is essential to select the appropriate modifier(s) based on the specific circumstances surrounding the procedure to ensure accurate billing and compliance with payer requirements.
Determining if CPT code 28112 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare, along with the associated reimbursement rates. To verify if CPT code 28112 is reimbursed, you would need to check the MPFS database for the current year.
Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect whether CPT code 28112 is reimbursed in your area. It's essential to review both the MPFS and any relevant LCDs from your MAC to confirm the reimbursement status of CPT code 28112.
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