CPT code 28118 is for the surgical removal of the heel bone, a procedure often necessary for various foot conditions.
CPT code 28118 is for the surgical removal of a portion of the heel bone, typically performed to address conditions such as bone spurs, fractures, or other abnormalities affecting the heel. This procedure may be indicated when conservative treatments have failed to alleviate pain or restore function.
When billing for the CPT code 28118, which pertains to the removal of the heel bone, 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 if multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed on a separate site or is distinct from other services provided on the same day.
4. Modifier LT - Left Side: Use this modifier to indicate 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 may be used if the procedure required significantly more work than typically required.
7. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable 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 During the Postoperative Period: This modifier should be used if a different procedure is performed during the postoperative period that is unrelated to the original procedure.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is relevant if an evaluation and management service is provided during the postoperative period that is unrelated to the procedure.
Each of these modifiers serves a specific purpose and helps to clarify the circumstances surrounding the procedure for accurate billing and reimbursement.
The CPT code 28118 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing guidelines that may affect reimbursement for CPT code 28118.
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