CPT code 28175 is for the surgical procedure to remove a tumor from the phalanx of a toe, ensuring accurate billing and documentation.
CPT code 28175 is used to describe the surgical procedure of resecting, or removing, a tumor located in the phalanx (the bone of the toe). This code specifically indicates that the procedure involves excising a tumor from the toe's bone structure, which may be necessary to treat conditions such as tumors or growths that could affect the toe's function or health.
When billing for the CPT code 28175, which pertains to the resection of a phalanx of a toe 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:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both toes or both feet simultaneously.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if the procedure is performed in conjunction with other surgical procedures on the same day.
3. Modifier 58 - Staged or Related Procedure: This modifier should be used if the procedure is part of a staged or planned series of procedures.
4. Modifier 78 - Unplanned Return to the Operating Room: This modifier is appropriate if the patient requires a return to the operating room for a related procedure within the global period.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician: Use this modifier if a different procedure is performed by the same physician during the global period that is unrelated to the original procedure.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is performed again by the same physician on the same day.
7. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure is performed by a different physician on the same day.
8. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is applicable if an unrelated E/M service is provided by the same physician during the postoperative period.
10. Modifier 59 - Distinct Procedural Service: This modifier should be used to indicate that a procedure was distinct or independent from other services performed on the same day.
It is essential to select the appropriate modifier based on the specific circumstances surrounding the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 28175 is reimbursed by Medicare, but the reimbursement specifics can vary. To determine if this particular CPT code is covered and the amount reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B. Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement rates for CPT code 28175.
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