CPT code 28225 is for the surgical release of a foot tendon, helping to alleviate pain and improve mobility in the foot.
CPT code 28225 is for the surgical procedure involving the release of a foot tendon. This code is used when a healthcare provider performs a surgical intervention to alleviate tension or restriction in a tendon located in the foot, which may be causing pain or limiting mobility. The procedure typically aims to restore normal function and improve the patient's quality of life by addressing issues such as tendonitis or other conditions affecting the foot's tendons.
When billing for the CPT code 28225, which pertains to the release 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, 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 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
Used when the procedure is part of a staged or related procedure.
4. Modifier 59 - Distinct Procedural Service
Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the procedure is repeated by the same provider.
6. 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
Indicates an unplanned return to the operating room for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Used when a procedure unrelated to the original procedure is performed during the postoperative period.
8. Modifier LT - Left Side
Indicates that the procedure was performed on the left foot.
9. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery
Used when a non-physician provider assists in the surgical procedure.
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.
The CPT code 28225 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates and guidelines for various CPT codes, including 28225. Additionally, MACs may have specific local coverage determinations (LCDs) that could affect the reimbursement process.
Therefore, it is crucial to review both the MPFS and any relevant MAC guidelines to ensure accurate billing and reimbursement for CPT code 28225.
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 28225, 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 underpayments.
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