CPT code 28299 is used for the surgical correction of hallux valgus, commonly known as a bunion, to improve foot alignment and function.
CPT code 28299 is used to describe a surgical procedure for the correction of hallux valgus, commonly known as a bunion. This code encompasses various techniques employed to realign the big toe and restore proper foot function, addressing both the deformity and any associated pain. It is typically utilized when the procedure does not fall under more specific codes for hallux valgus correction, indicating a more complex or individualized surgical approach.
When billing for CPT code 28299, 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 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: Use this modifier if the procedure required significantly more work than typically required.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
6. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed 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 within the global period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician: Use this modifier if a procedure unrelated to the original procedure is performed by the same physician during the global period.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if the procedure involves a repeat test or service.
10. Modifier 52 - Reduced Services: Use this modifier if the service provided is less than what is typically required for the procedure.
It is essential to choose the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 28299 is reimbursed by Medicare, but its reimbursement is subject to specific conditions 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 28299 may also depend on the guidelines and policies set forth by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and can provide additional information on any local coverage determinations (LCDs) that may affect the reimbursement of this specific CPT code. Therefore, it is advisable to consult both the MPFS and your regional MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 28299.
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