CPT code 28289 is for correcting a bunion (hallux rigidus) without using an implant in a surgical procedure.
CPT code 28289 is used to describe a surgical procedure for correcting a bunion (hallux rigidus) without the use of an implant. This procedure typically involves realigning the bones of the big toe to alleviate pain and improve function, addressing the stiffness and discomfort associated with this condition.
When billing for CPT code 28289, which pertains to the correction of hallux rigidus without the use of an implant, 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 surgical 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 78 - Unplanned Return to the Operating Room: This modifier should be used if the patient requires a return to the operating room for a related procedure within the postoperative period.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is appropriate if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
6. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is applicable if an evaluation and management service is provided during the postoperative period that is unrelated to the original procedure.
8. Modifier 26 - Professional Component: Use this modifier if only the professional component of the service is being billed.
9. Modifier TC - Technical Component: This modifier is used if only the technical component of the service is being billed.
10. Modifier KX - Requirements Met: This modifier indicates that specific coverage requirements have been met for the service being billed.
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.
CPT code 28289 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any potential coverage limitations, healthcare providers should consult the MPFS.
Additionally, it is essential to verify with the respective Medicare Administrative Contractor (MAC) for any regional variations or additional guidelines that may apply to the reimbursement of CPT code 28289.
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