CPT code 28190 is for the removal of a foreign body from the foot, helping healthcare providers bill accurately for this procedure.
CPT code 28190 is the procedure for the removal of a foreign body from the foot. This code is used when a healthcare provider performs a surgical intervention to extract an object that has become lodged in the foot tissue, which may include items like splinters, glass, or other debris. The procedure typically involves making an incision to access the foreign body and ensure its complete removal to prevent infection or further complications.
When billing for the CPT code 28190, which pertains to the removal of a foot foreign body, 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
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 is 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 more than once by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Used when a patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Indicates that a procedure was performed that is unrelated to the original procedure during the postoperative period.
7. Modifier LT - Left Side
Used to specify that the procedure was performed on the left foot.
8. Modifier RT - Right Side
Used to specify that the procedure was performed on the right foot.
9. Modifier 22 - Increased Procedural Services
Indicates that the procedure required significantly more work than usual.
10. Modifier 27 - Multiple Encounters on the Same Date
Used when a patient has multiple encounters on the same date of service.
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.
CPT code 28190 is reimbursed by Medicare, but the specifics of reimbursement can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) outlines the payment rates for services covered under Medicare Part B, including CPT code 28190. However, the final determination of reimbursement is often made by the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and any potential local variations in reimbursement for CPT code 28190. It is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding reimbursement for this specific code.
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 28190, 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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