CPT code 28226 is for the surgical release of foot tendons, helping to alleviate pain and improve mobility in patients.
CPT code 28226 is for the surgical procedure involving the release of foot tendons. This procedure is typically performed to alleviate pain or improve function in the foot by cutting or loosening the tendons that may be causing restriction or discomfort. It is often indicated for conditions such as tendonitis or other issues affecting the mobility of the foot.
When billing for the CPT code 28226 (Release of foot tendons), 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 treatment plan or a related procedure performed during the postoperative period.
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 same procedure is repeated on the same day 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 that a return to the operating room was necessary due to complications or issues related to the initial 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 is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot.
9. Modifier LT - Left Side
Indicates that the procedure was performed on the left foot.
10. Modifier 22 - Increased Procedural Services
Used when the procedure required significantly more work than typically required.
It is essential for healthcare providers to select the appropriate modifiers based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 28226 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any additional guidelines, healthcare providers should consult the MPFS, which provides detailed information on the payment policies for various CPT codes.
Additionally, it is essential to verify with the local Medicare Administrative Contractor (MAC) as they may have specific coverage policies or requirements that could affect reimbursement. Each MAC can have variations in their interpretation and implementation of Medicare policies, so checking with the local MAC ensures compliance and accurate reimbursement.
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 28226, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
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
