CPT code 28298 is for the surgical correction of hallux valgus, commonly known as a bunion, to improve foot alignment and function.
CPT code 28298 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, which can alleviate pain and improve function. It typically includes the removal of any bony prominence and may involve the use of screws or other fixation devices to stabilize the corrected position.
When billing for CPT code 28298, which pertains to the correction of hallux valgus, there are several modifiers that may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. -50: Bilateral Procedure
- Used when the procedure is performed on both feet.
2. -RT: Right Side
- Indicates that the procedure was performed on the right foot.
3. -LT: Left Side
- Indicates that the procedure was performed on the left foot.
4. -59: Distinct Procedural Service
- Used to indicate that the procedure is separate and distinct from other services performed on the same day.
5. -76: Repeat Procedure by Same Physician
- Indicates that the procedure was repeated by the same physician on the same day.
6. -78: Unplanned Return to the Operating/Procedure Room by the Same Physician
- Used when a patient requires a return to the operating room for a related procedure within the global period.
7. -79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Indicates that a procedure was performed that is unrelated to the original procedure during the postoperative period.
8. -XU: Unusual Non-Overlapping Service
- Used to indicate that the service is distinct because it does not overlap with other services provided.
9. -52: Reduced Services
- Indicates that the service was partially reduced or eliminated at the physician's discretion.
10. -53: Discontinued Procedure
- Used when a procedure is terminated due to extenuating circumstances or those that threaten the well-being of the patient.
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.
CPT code 28298 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 28298 may also depend on the policies of the Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide additional guidance on any local coverage determinations (LCDs) or specific documentation requirements that may apply. Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure compliance and accurate reimbursement for CPT code 28298.
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 28298, 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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