CPT code 28296 is for the surgical correction of hallux valgus, commonly known as a bunion, to improve foot alignment and function.
CPT code 28296 is for the surgical correction of hallux valgus, commonly known as a bunion. This procedure involves realigning the big toe and correcting the deformity at the base of the toe to alleviate pain and improve function. It typically includes the removal of the bony prominence and may involve the use of screws or other fixation devices to stabilize the corrected position.
When billing for CPT code 28296, 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 if the procedure is performed on the left foot.
3. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right foot.
4. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required, justifying additional reimbursement.
5. Modifier 59 - Distinct Procedural Service: Use this modifier if the procedure is performed separately from other procedures on the same day, indicating that it is not part of a bundled service.
6. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier 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: Use this modifier if a different procedure is performed by the same physician during the postoperative period.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if the procedure involves a repeat test or service that is clinically necessary.
It is essential to select the appropriate modifier based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
CPT code 28296 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates and guidelines for services covered by Medicare.
Additionally, the reimbursement for CPT code 28296 may vary depending on the region, as Medicare Administrative Contractors (MACs) have the authority to interpret national policies and establish local coverage determinations.
Therefore, it is essential for healthcare providers to consult the MPFS and their respective MAC to ensure compliance and accurate reimbursement for CPT code 28296.
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 28296, 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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