CPT code 28202 is for the repair or grafting of a tendon in the foot, used for billing and documentation in healthcare services.
CPT code 28202 is used to describe a surgical procedure involving the repair or grafting of a tendon in the foot. This code indicates that the healthcare provider has performed a surgical intervention to restore the function of a damaged tendon, which may involve suturing the tendon back together or using a graft to replace or reinforce the damaged area. This procedure is typically necessary for patients who have experienced tendon injuries that affect their mobility or overall foot function.
When billing for the CPT code 28202, which pertains to the repair or graft of a foot tendon, 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 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: This modifier is appropriate if the procedure is a staged or related procedure that is performed during the postoperative period of another procedure.
4. Modifier 59 - Distinct Procedural Service: Use this modifier when the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating Room: This modifier should be used if the patient requires a return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier is used when the procedure is performed by a non-physician provider.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 28202 is reimbursed by Medicare, but the specifics of reimbursement can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 28202. However, the final determination of reimbursement is often made by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and any potential local coverage determinations (LCDs) that might affect reimbursement for CPT code 28202. It is advisable to consult the MPFS and your regional MAC to confirm the exact reimbursement details for this code.
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