CPT code 28232 is a medical billing code used for the incision of a toe tendon procedure in healthcare.
CPT code 28232 is for the surgical procedure involving the incision of a tendon in the toe. This code is typically used when a healthcare provider performs an operation to access and treat issues related to the tendon, which may include conditions such as tendonitis or tendon tears. The procedure aims to relieve pain, restore function, or address other complications associated with the toe's movement.
When billing for the CPT code 28232, various 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: This modifier is appropriate if the procedure is a staged procedure or if it is related to a previous procedure performed during the same surgical session.
4. Modifier 78 - Unplanned Return to the Operating Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the postoperative period.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is applicable if a procedure is performed that is unrelated to the original procedure during the postoperative period.
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: Use this modifier if billing for the professional component of the service when the technical component is billed separately.
8. Modifier TC - Technical Component: This modifier is used when billing for the technical component of the service separately from the professional component.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier may be used if the procedure involves repeat testing or services that are necessary for the patient's care.
10. Modifier 59 - Distinct Procedural Service: This modifier is applicable when the procedure is distinct or independent from other services performed on the same day.
It is essential to evaluate the specific circumstances of the procedure to determine which modifiers are appropriate for accurate billing and compliance.
CPT code 28232 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to obtain precise information on the reimbursement rate and any specific billing requirements for CPT code 28232.
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