CPT code 28290 is a medical billing code used for the surgical correction of a bunion, helping providers accurately document and bill for the procedure.
CPT code 28290 is the procedure code used for the surgical correction of a bunion, which is a deformity characterized by a bony bump on the joint at the base of the big toe. This code specifically refers to the surgical intervention aimed at realigning the bones and tissues to alleviate pain and restore normal function of the foot.
When billing for the CPT code 28290 (Correction of bunion), 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 correction of the bunion is performed alongside other surgical procedures during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier should be used if the procedure is a staged or related procedure that is performed during the postoperative period of a previous surgery.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is appropriate if the patient requires a return to the operating room for a related procedure within the global period of the initial surgery.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Use this modifier if a different procedure is performed during the postoperative period that is unrelated to the initial bunion correction.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier can be used if a laboratory test related to the procedure is repeated on the same day.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and appropriate reimbursement for healthcare providers.
The CPT code 28290 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment rates.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, healthcare providers should consult their respective MAC for precise information on the reimbursement rates and any potential coverage limitations for CPT code 28290.
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 CPT code 28290, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
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