CPT code 28293 is for the surgical correction of a bunion, a common foot deformity that causes pain and misalignment.
CPT code 28293 is for the surgical correction of a bunion, which is a bony bump that forms at the base of the big toe. This procedure typically involves realigning the bones of the foot to relieve pain and improve function. It may include removing the bony prominence and correcting any associated deformities in the surrounding structures.
When billing for the CPT code 28293, which pertains to the correction of a bunion, several modifiers may be applicable depending on the specific circumstances of the procedure. Below 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 can be used if the procedure required significantly more work than typically required.
5. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure was distinct or independent from other services performed on the same day.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient returns to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if a different procedure is performed by the same physician during the postoperative period.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier may be used if a repeat test is performed on the same day.
10. Modifier 52 - Reduced Services: This modifier can be used if the service provided is less than what is typically required for the procedure.
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 28293 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 reimbursement rates.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 28293. Each MAC may have unique guidelines and policies, so checking with them ensures compliance and accurate reimbursement.
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