CPT code 28119 is for the surgical removal of a heel spur, a bony growth on the underside of the heel bone.
CPT code 28119 is the procedure code used for the surgical removal of a heel spur. This code specifically indicates that the healthcare provider has performed an excision of the bony growth on the heel, which is often associated with pain and discomfort. The procedure typically involves making an incision to access the spur and remove it, thereby alleviating symptoms and improving the patient's mobility.
When billing for the CPT code 28119, which pertains to the removal of a heel spur, 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. -50: Bilateral Procedure
Used when the procedure is performed on both feet.
2. -RT: Right Side
Indicates that the procedure was performed on the right foot.
3. -LT: Left Side
Indicates that the procedure was performed on the left foot.
4. -59: Distinct Procedural Service
Used to indicate that the procedure is separate and distinct from other services performed on the same day.
5. -76: Repeat Procedure by Same Physician
Indicates that the same procedure was performed again by the same physician on the same day.
6. -78: Unplanned Return to the Operating/Procedure Room
Used when a patient returns to the operating room for a related procedure within the global period.
7. -79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Indicates that a procedure was performed that is unrelated to the original procedure during the postoperative period.
8. -22: Increased Procedural Services
Used when the work required to provide a service is substantially greater than typically required.
9. -52: Reduced Services
Indicates that the service was reduced at the physician's discretion.
10. -53: Discontinued Procedure
Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
Each of these modifiers serves a specific purpose and should be used based on the clinical scenario to ensure accurate billing and compliance with payer requirements.
The CPT code 28119 is subject to reimbursement by Medicare, but its eligibility for payment depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource that outlines the payment rates for services covered by Medicare. To determine if CPT code 28119 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated reimbursement rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 28119 is covered in a particular jurisdiction. Providers should check with their respective MAC to ensure compliance with local coverage determinations and any additional documentation requirements that may affect reimbursement.
In summary, while CPT code 28119 can be reimbursed by Medicare, it is essential to consult both the MPFS and the relevant MAC to confirm coverage and payment details.
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