CPT code 28240 is for the surgical release of the big toe, often performed to alleviate pain or improve function.
CPT code 28240 is the procedure for the surgical release of the big toe. This typically involves the correction of a deformity or the alleviation of pain by addressing issues such as bunions or other conditions affecting the joint or soft tissues of the big toe. The procedure aims to restore normal function and improve the patient's quality of life.
When billing for CPT code 28240, which pertains to the release of the big toe, 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 is applicable if multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used when the procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left foot.
5. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right foot.
6. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period: This modifier is appropriate if an unrelated service is provided during the postoperative period.
8. Modifier 78 - Return to the Operating Room for a Related Procedure During the Postoperative Period: Use this modifier if a related procedure is performed during the postoperative period.
9. 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 an unrelated procedure is performed during the postoperative period.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements.
The CPT code 28240 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.
Additionally, reimbursement for CPT code 28240 may vary depending on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region. Each MAC has the authority to interpret national Medicare policies and may have specific guidelines or requirements for reimbursement.
Therefore, it is advisable to consult the MPFS and your local MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 28240.
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