CPT code 28120 is for the surgical removal of part of the ankle or heel, used for billing and documentation in healthcare services.
CPT code 28120 is for the surgical procedure involving the partial removal of bone from the ankle or heel. This code is typically used when a healthcare provider performs a procedure to alleviate pain or address a specific condition affecting the ankle or heel area, such as a bone spur or other abnormalities.
When billing for the CPT code 28120, which pertains to the partial removal of the ankle or heel, 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 sides of the body.
2. Modifier 51 - Multiple Procedures: This modifier indicates that multiple procedures were performed during the same session.
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.
4. Modifier LT - Left Side: This modifier specifies that the procedure was performed on the left side of the body.
5. Modifier RT - Right Side: This modifier specifies that the procedure was performed on the right side of the body.
6. Modifier 22 - Increased Procedural Services: This modifier is used when the procedure performed is significantly more complex or requires more time than usual.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier indicates that a procedure was repeated by the same physician on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used when a patient requires an unplanned return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier indicates that a procedure was performed that is unrelated to the original procedure during the postoperative period.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is used when an evaluation and management service is provided that is unrelated to the procedure performed during the postoperative 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 28120 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 28120. It is essential for healthcare providers to consult both the MPFS and their respective MAC to ensure compliance with Medicare's guidelines and to understand the exact reimbursement details for this specific CPT code.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. With RevFind, you can identify discrepancies for CPT code 28120 and ensure you are receiving the correct reimbursements. Schedule a demo today to see how our solution can help you optimize your revenue.
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