CPT code 28130 is for the surgical removal of an ankle bone, helping healthcare providers accurately bill for this specific procedure.
CPT code 28130 is the procedure for the surgical removal of a bone from the ankle. This code is typically used when a healthcare provider performs an operation to excise a bone, often due to conditions such as arthritis, bone tumors, or other pathologies affecting the ankle joint. The procedure aims to alleviate pain, restore function, or address structural issues within the ankle.
When billing for the CPT code 28130 (Removal of ankle 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 ankles.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple surgical procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is part of a staged surgical approach or if it is a subsequent procedure related to a previous surgery.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is appropriate if a return to the operating room is necessary due to complications related to the initial procedure.
5. 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 separate, unrelated procedure is performed during the postoperative period of the initial surgery.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
7. Modifier 26 - Professional Component: If the procedure is billed separately for the professional component, this modifier should be used.
8. Modifier TC - Technical Component: This modifier is applicable if billing for the technical component of the procedure separately.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: If applicable, this modifier can be used for repeat tests related to the procedure.
10. Modifier 99 - Multiple Modifiers: This modifier is used when more than one modifier is applicable to the procedure.
It is essential to review the specific circumstances of the procedure and consult payer guidelines to determine the appropriate modifiers to use for accurate billing and reimbursement.
The CPT code 28130 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate.
The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.
Additionally, it is crucial 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 28130.
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 specific codes like 28130, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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