CPT code 28260 is for the surgical release of the midfoot joint, helping to describe the specific procedure performed for billing and documentation.
CPT code 28260 is the procedure for the release of the midfoot joint. This involves surgically freeing the joints in the midfoot area, which may be necessary to alleviate pain or restore function due to conditions such as arthritis, deformities, or injuries. The procedure aims to improve mobility and reduce discomfort in the foot by addressing issues within the midfoot joints.
When billing for the CPT code 28260 (Release of midfoot joint), 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 58 - Staged or Related Procedure: Use this modifier if the procedure is part of a staged or related procedure that is performed during the postoperative period.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the same procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the postoperative period.
7. 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.
8. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left foot.
9. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right foot.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier is used when the service is performed by a non-physician provider.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 28260 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 28260. To determine the exact reimbursement amount, healthcare providers should refer to the MPFS, which is updated annually.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding coverage and reimbursement for CPT code 28260. Providers should consult their respective MAC for detailed guidance on billing and reimbursement for this code.
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 RevFind, you can identify discrepancies related to CPT code 28260, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can help you optimize your revenue and minimize losses.
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
