CPT code 28294 is a medical billing code used for the surgical correction of a bunion, helping healthcare providers accurately document procedures.
CPT code 28294 is used to describe the surgical procedure for the correction of a bunion, which is a deformity of the big toe joint. This code specifically refers to the surgical intervention that may involve realigning the bones of the foot and removing any excess bone to alleviate pain and improve function. It is typically performed when conservative treatments have failed to provide relief.
When billing for the CPT code 28294, which pertains to the correction of a 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 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 59 - Distinct Procedural Service: Use this modifier when the procedure is 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 requires a return to the operating room for a related procedure within 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 laboratory test related to the procedure is repeated.
Each of these modifiers serves to provide additional context for the procedure performed and can help ensure accurate billing and reimbursement. It is essential to select the appropriate modifier based on the specific circumstances surrounding the procedure.
The CPT code 28294 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) for the specific year in question. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) for your region. Each MAC may have specific guidelines and requirements that could affect the reimbursement process for CPT code 28294. Therefore, it is advisable to consult the latest MPFS and your regional MAC to ensure accurate and up-to-date information regarding reimbursement.
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. With RevFind, you can identify discrepancies for specific codes like 28294, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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