CPT code 28264 is for the surgical release of the midfoot joint, helping to document and bill for this specific procedure in healthcare.
CPT code 28264 is for the surgical procedure involving the release of a midfoot joint. This procedure typically addresses conditions such as joint stiffness or deformities in the midfoot area, allowing for improved mobility and function. It may involve the cutting of ligaments or other soft tissues to relieve pressure and restore normal movement in the affected joint.
When billing for the CPT code 28264 (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 the procedure is performed in conjunction with other surgical procedures on the same day.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician: Use this modifier if the procedure is part of a staged treatment plan or if it is a subsequent procedure related to a previous one.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure: This modifier is appropriate if the patient requires an unplanned return to the operating room for a related procedure within the global period.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier should be used if a completely unrelated procedure is performed during the postoperative period of the initial procedure.
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: If the procedure is billed separately for the professional component, this modifier should be applied.
8. Modifier TC - Technical Component: This modifier is used if billing for the technical component of the procedure separately.
9. Modifier 59 - Distinct Procedural Service: This modifier is applicable when the procedure is distinct or independent from other services performed on the same day.
10. Modifier KX - Requirements Met: This modifier is used to indicate that specific requirements for coverage have been met, particularly for certain services that may have additional documentation requirements.
It is essential to review the specific circumstances of the procedure and the payer guidelines to determine the appropriate modifiers to use when billing for CPT code 28264.
The CPT code 28264 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 can vary based on the policies of the Medicare Administrative Contractor (MAC) in your specific region.
Therefore, it is advisable to consult the MPFS and your local MAC to confirm the reimbursement details for CPT code 28264.
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