CPT code 28171 is a medical billing code used to describe the surgical removal of a tumor from the tarsal area of the foot.
CPT code 28171 is used to describe the surgical procedure of resecting a tumor located in the tarsal region of the foot. This code indicates that a healthcare provider has performed an excision of a tumor, which may involve removing the tumor along with some surrounding tissue to ensure complete removal and to prevent recurrence. This procedure is typically performed when the tumor is causing pain, discomfort, or other complications for the patient.
When billing for the CPT code 28171, which pertains to the resection of a tarsal tumor, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both feet.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 59 - Distinct Procedural Service
Used to indicate that the procedure was distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
Applied when the same procedure is performed again by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Indicates that a patient returned to the operating room for a related procedure during the postoperative period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a different procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier LT - Left Side
Indicates that the procedure was performed on the left foot.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot.
9. Modifier 22 - Increased Procedural Services
Used when the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Applicable if the patient had multiple evaluation and management encounters on the same day.
It is essential to review the specific circumstances of the procedure and the payer guidelines to determine the appropriate modifiers to use when billing for CPT code 28171.
CPT code 28171 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 the corresponding payment rates. To determine the exact reimbursement rate and any additional requirements, healthcare providers should consult the MPFS directly.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and providing guidance on Medicare coverage. Each MAC may have specific local coverage determinations (LCDs) that could affect the reimbursement of CPT code 28171. Therefore, it is advisable for healthcare providers to check with their respective MAC to ensure compliance with any local policies and to obtain the most accurate reimbursement information.
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 28171, 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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