CPT code 28200 is for the surgical repair of a tendon in the foot, used for billing and documentation in healthcare services.
CPT code 28200 is for the surgical repair of a tendon in the foot. This procedure typically involves addressing issues such as tendon tears or ruptures, allowing for the restoration of function and mobility in the affected area. It is commonly performed to alleviate pain and improve the patient's ability to walk or engage in other activities.
When billing for the CPT code 28200, 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 feet.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple 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: This modifier is appropriate if the procedure is part of a staged treatment plan.
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: Use this modifier 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: This modifier is applicable if a different procedure is performed during the postoperative period that is unrelated to the initial procedure.
6. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
7. Modifier 26 - Professional Component: If billing separately for the professional component of the procedure, this modifier should be used.
8. Modifier TC - Technical Component: This modifier is used when billing for the technical component of the procedure separately.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: If a repeat procedure is performed on the same day, this modifier may be applicable.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and reimbursement in accordance with the specific circumstances surrounding the treatment.
The CPT code 28200 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.
However, the final determination of reimbursement for CPT code 28200 may also depend on the guidelines set forth by the Medicare Administrative Contractor (MAC) in your specific region. MACs are responsible for interpreting national policies and making local coverage decisions, which can influence whether and how a particular CPT code is reimbursed.
Therefore, it is essential to consult both the MPFS and your regional MAC to confirm the reimbursement status and any additional requirements for CPT code 28200.
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 CPT code 28200 and ensure you are receiving the correct reimbursements. Schedule a demo today to see how our solution can optimize your revenue recovery process.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
