CPT code 28297 is used to describe the surgical correction of hallux valgus, commonly known as a bunion.
CPT code 28297 is for the surgical correction of hallux valgus, commonly known as a bunion. This procedure involves realigning the big toe and correcting the bony prominence at the base of the toe to alleviate pain and improve function. It typically includes the removal of the bunion and may involve the repositioning of bones or soft tissues to restore proper alignment.
When billing for CPT code 28297, 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: This modifier is used when the procedure is performed on both feet.
2. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
3. Modifier RT - Right Side: This modifier indicates 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: This modifier is used to indicate that 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: This modifier is used if a 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 applicable if a different procedure is performed by the same physician during the postoperative period.
9. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: This modifier may be used if multiple evaluation and management services are provided on the same day.
Each of these modifiers serves to provide additional context for the procedure performed and can affect reimbursement and claims processing. It is essential to select the appropriate modifier based on the specific circumstances surrounding the procedure to ensure accurate billing and compliance.
CPT code 28297 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable coverage limitations, healthcare providers should consult the MPFS.
Additionally, it is essential to verify with the respective Medicare Administrative Contractor (MAC) for any local coverage determinations (LCDs) or specific billing requirements that may affect reimbursement for CPT code 28297.
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