CPT code 28280 is a medical billing code used for the surgical fusion of toes, helping healthcare providers accurately document and bill for the procedure.
CPT code 28280 is the designation for a surgical procedure involving the fusion of the toes. This procedure typically aims to alleviate pain or improve function in the affected toe(s) by permanently joining the bones together. It is often indicated for conditions such as severe arthritis or deformities that do not respond to conservative treatments.
When billing for the CPT code 28280 (Fusion of toes), 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 fusion of toes is performed on both feet during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if the fusion of toes is performed alongside other surgical procedures during the same operative session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician: This modifier should be used if the fusion of toes is part of a staged procedure or if it is a subsequent procedure related to a previous surgery.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician: This modifier is appropriate if the patient requires an unplanned return to the operating room for complications related to the fusion of toes.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if a different procedure is performed during the postoperative period that is unrelated to the fusion of toes.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required for a standard fusion of toes.
7. Modifier 26 - Professional Component: This modifier is applicable if billing separately for the professional component of the procedure, such as the interpretation of imaging studies related to the fusion.
8. Modifier TC - Technical Component: Use this modifier if billing separately for the technical component of the procedure, such as the facility or equipment used during the fusion.
Each of these modifiers serves to provide additional context for the procedure performed and can help ensure accurate reimbursement and proper documentation in the healthcare revenue cycle management process.
The CPT code 28280 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 28280.
It is essential for healthcare providers to consult both the MPFS and their respective MAC guidelines to ensure compliance and accurate reimbursement for this CPT code.
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