CPT code 28286 is for the surgical repair of a hammertoe, a condition where a toe bends abnormally.
CPT code 28286 is for the surgical repair of a hammertoe, a condition where one or more toes are bent at the middle joint, causing them to resemble a hammer. This procedure typically involves correcting the deformity by realigning the toe and may include the removal of a portion of bone or soft tissue to restore normal function and appearance.
When billing for CPT code 28286 (Repair of hammertoe), 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 appropriate when multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional: This modifier should be used if the procedure is part of a staged treatment plan.
4. Modifier 59 - Distinct Procedural Service: This modifier indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the procedure is repeated by the same provider.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure: This modifier is applicable if a return to the operating room is necessary due to complications related to the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: This modifier is used if a completely unrelated procedure is performed during the postoperative period of the initial procedure.
8. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
9. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
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 28286 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 and the corresponding payment rates. However, it is important to note that the final determination of reimbursement for CPT code 28286 may also depend on the policies of the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can have localized coverage decisions that affect whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult the MPFS and your regional MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 28286.
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