CPT code 28308 is for the surgical incision of a metatarsal bone, commonly performed to treat foot conditions.
CPT code 28308 is for the surgical procedure involving the incision of a metatarsal bone in the foot. This code is typically used when a healthcare provider performs an operation to access the metatarsal for various reasons, such as to treat a fracture, remove a bone spur, or address other conditions affecting the bone. The procedure may involve cutting through the skin and underlying tissues to reach the metatarsal, allowing for necessary intervention.
When billing for CPT code 28308 (Incision of metatarsal), 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 (bilateral).
2. Modifier 51 - Multiple Procedures: This modifier is appropriate if multiple surgical procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier should be used if the procedure is part of a staged or related procedure that is performed during the postoperative period.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable if the patient requires a return to the operating room for a related procedure within the global period.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: Use this modifier if a different procedure is performed by the same provider during the postoperative period that is unrelated to the original procedure.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
7. Modifier 26 - Professional Component: If the procedure is being billed separately for the professional component, this modifier should be applied.
8. Modifier TC - Technical Component: This modifier is used if billing for the technical component of the procedure separately.
9. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is distinct or independent from other services performed on the same day.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: If applicable, this modifier can be used when a laboratory test is repeated on the same day.
It is essential to evaluate the specific circumstances of the procedure to determine which modifiers are appropriate for accurate billing and compliance with payer requirements.
The CPT code 28308 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including their respective reimbursement rates.
Additionally, MACs may have localized policies or guidelines that could affect the reimbursement of CPT code 28308.
Therefore, it is advisable to consult both the MPFS and your MAC to ensure accurate and up-to-date information regarding the reimbursement of this specific 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. With RevFind, you can identify discrepancies for specific codes like 28308, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your processes and improve your bottom line.
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