CPT code 28113 is for the partial removal of a metatarsal bone in the foot, used for billing and documentation in healthcare services.
CPT code 28113 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-related issues.
When billing for the CPT code 28113, 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: This modifier is used when the procedure is performed on both feet. It indicates that the service was bilateral and may affect reimbursement.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same session. It informs payers that additional procedures were conducted, which may require adjustments in reimbursement.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure was distinct or independent from other services performed on the same day. It is essential when the procedure is not typically bundled with other services.
4. Modifier LT - Left Side: This modifier specifies that the procedure was performed on the left foot. It is important for accurate documentation and billing.
5. Modifier RT - Right Side: Similar to Modifier LT, this modifier indicates that the procedure was performed on the right foot.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is performed again by the same physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if a patient requires a return to the operating room for complications related to the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if a different procedure is performed by the same physician during the postoperative period of the initial procedure.
It is crucial for healthcare providers to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
CPT code 28113 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 respective reimbursement rates.
Additionally, it is advisable to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may apply to the reimbursement of CPT code 28113. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies.
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