CPT code 28122 is for the partial removal of a foot bone, used for billing and documentation in healthcare services.
CPT code 28122 is for the partial removal of a bone in the foot. This procedure typically involves excising a portion of a bone to address issues such as deformities, infections, or other conditions affecting the foot's structure and function.
When billing for the CPT code 28122, 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 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 when the procedure is performed on the left foot.
5. Modifier RT - Right Side: This modifier is used when the procedure is performed on the right foot.
6. Modifier 78 - Return to the Operating Room for a Related Procedure: This modifier is applicable if the patient requires a return to the operating room for a related procedure within the global period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Use this modifier if a different procedure is performed during the postoperative period that is unrelated to the original procedure.
8. Modifier 26 - Professional Component: This modifier is used when billing for the professional component of a service that has both a professional and technical component.
9. Modifier TC - Technical Component: This modifier is applicable when billing for the technical component of a service that has both a professional and technical component.
10. Modifier KX - Requirements Met: This modifier indicates that the requirements of a specific coverage policy have been met, which may be necessary for certain payers.
Each of these modifiers serves a specific purpose and helps to provide additional context for the services rendered, ensuring accurate billing and compliance with payer requirements.
CPT code 28122 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. To determine the exact reimbursement rate for CPT code 28122, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement rates. Therefore, it is advisable for healthcare providers to consult their respective MAC for detailed information on the reimbursement of CPT code 28122.
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. For instance, with CPT code 28122, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you maximize your revenue and minimize losses.
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