CPT code 28305 is a medical billing code used for incising or grafting midfoot bones during surgical procedures.
CPT code 28305 is used to describe a surgical procedure involving the incision and grafting of the bones in the midfoot area. This code indicates that the healthcare provider is performing a surgical intervention to repair or reconstruct the bones located in the middle section of the foot, which may be necessary due to injury, deformity, or other medical conditions affecting the midfoot structure.
When billing for CPT code 28305 (Incise/graft midfoot bones), 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 51 - Multiple Procedures: This modifier is appropriate when multiple procedures are performed during the same session, including the primary procedure.
3. Modifier 58 - Staged or Related Procedure: This modifier should be used if the procedure is a staged or related procedure that is performed during the postoperative period of another procedure.
4. Modifier 59 - Distinct Procedural Service: This modifier is applicable when the procedure is distinct or independent from other services performed on the same day.
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 78 - Unplanned Return to the Operating/Procedure Room: This modifier is relevant if the patient requires a return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
9. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
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 28305 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including the associated reimbursement rates. To determine the exact reimbursement for CPT code 28305, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide localized information regarding coverage and reimbursement rates for CPT code 28305. Providers should consult their respective MAC for detailed guidance on billing and reimbursement for this specific code.
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