CPT code 28173 is a medical billing code used to describe the surgical removal of a tumor from the metatarsal bone in the foot.
CPT code 28173 is used to describe the surgical procedure of resecting a tumor located in the metatarsal bone of the foot. This code indicates that a healthcare provider has performed an excision of a tumor, which may involve removing part or all of the affected metatarsal bone to ensure complete removal of the tumor and to promote healing. This procedure is typically indicated for patients with benign or malignant tumors in that area.
When billing for the CPT code 28173, which pertains to the resection of a metatarsal 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 LT - Left Side
Indicates that the procedure was performed on the left foot.
5. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot.
6. Modifier 76 - Repeat Procedure by Same Physician
Used when the same procedure is performed again by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician
Indicates that the same procedure was performed again by a different physician on the same day.
8. Modifier 22 - Increased Procedural Services
Used when the procedure performed is significantly more complex or requires more work than typically required.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
Indicates that an evaluation and management service was provided during the postoperative period for a reason unrelated to the original procedure.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Used when multiple evaluation and management services are provided on the same day in an outpatient setting.
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.
The CPT code 28173 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage criteria through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare.
Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may apply to CPT code 28173. The MACs are responsible for processing Medicare claims and can provide guidance on any nuances related to the reimbursement of this code.
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