CPT code 28306 is for the surgical incision of a metatarsal bone, typically performed to address foot conditions or injuries.
CPT code 28306 is used to describe the surgical procedure involving the incision of a metatarsal bone in the foot. This procedure may be performed to address various conditions affecting the metatarsal, such as fractures, deformities, or other pathologies that require surgical intervention. The code specifically indicates that the incision is made to facilitate treatment, which may include realignment, removal of bone spurs, or other corrective measures.
When billing for the CPT code 28306 (Incision of metatarsal), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both feet.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
Used when the procedure is part of a staged or related procedure that occurs during the postoperative period.
4. Modifier 59 - Distinct Procedural Service
Indicates that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Used when the same procedure is repeated by the same provider on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
Indicates an unplanned return to the operating room for a related procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier LT - Left Side
Indicates that the procedure was performed on the left foot.
9. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot.
10. Modifier 22 - Increased Procedural Services
Used when the work required to provide a service is substantially greater than typically required.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 28306 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 allowable payment amounts for services covered under Medicare Part B.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the reimbursement rates and coverage policies for CPT code 28306 in their respective jurisdictions. It is essential for healthcare providers to consult both the MPFS and their local MAC guidelines to ensure accurate billing and reimbursement for this CPT code.
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. For instance, with CPT code 28306, RevFind identifies discrepancies that could impact your bottom line. Schedule a demo today to see how our solution can help you recover lost revenue and optimize your financial performance.
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