CPT code 28292 is used to describe the surgical correction of hallux valgus, commonly known as a bunion.
CPT code 28292 is used to describe a surgical procedure for the correction of hallux valgus, commonly known as a bunion. This code specifically refers to the surgical intervention that involves the realignment of the big toe and the correction of the associated deformity in the foot. The procedure may include osteotomy, which is the cutting and repositioning of the bone, to restore proper alignment and alleviate pain or discomfort associated with the condition.
When billing for CPT code 28292, which pertains to the correction of hallux valgus, 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 LT - Left Side: Use this modifier to indicate that the procedure was performed on the left foot.
3. Modifier RT - Right Side: Use this modifier to indicate that the procedure was performed on the right foot.
4. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated on the same foot by the same physician on the same day.
6. Modifier 59 - Distinct Procedural Service: This modifier may be applicable if the procedure is performed in a distinct anatomical location or if it is separate from other procedures performed on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is appropriate if a different procedure is performed during the postoperative period that is unrelated to the initial procedure.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Use this modifier if an evaluation and management service is provided during the postoperative period that is unrelated to the procedure.
10. Modifier 52 - Reduced Services: This modifier may be used if the procedure is partially reduced or eliminated at the physician's discretion.
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 28292 is subject to reimbursement by Medicare, but its eligibility and the amount reimbursed depend on several factors. Primarily, the Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining the reimbursement rates for this code. The MPFS is updated annually and outlines the payment rates for services provided by physicians and other healthcare professionals.
Additionally, Medicare Administrative Contractors (MACs) are responsible for processing Medicare claims and can influence the reimbursement process. MACs may have specific local coverage determinations (LCDs) that affect whether CPT code 28292 is reimbursed in a particular region. Therefore, it is essential to consult the MPFS and the relevant MAC guidelines to ascertain the reimbursement status and rate for CPT code 28292.
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