CPT code 28309 is for the surgical incision of metatarsals, typically performed to address foot conditions or injuries.
CPT code 28309 is for the surgical procedure involving the incision of the metatarsals, which are the long bones in the foot located between the tarsal bones and the phalanges. This procedure may be performed to address various conditions affecting the metatarsals, such as fractures, deformities, or other pathologies that require surgical intervention. The code specifically indicates that the incision is made to access and treat issues related to these bones, facilitating proper healing or correction of the underlying problem.
When billing for CPT code 28309, various 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 applicable if multiple surgical procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: Use this modifier if the procedure is part of a staged or related procedure that occurs during the postoperative period.
4. Modifier 78 - Unplanned Return to the Operating Room: This modifier should be used if the patient requires a return to the operating room for a related procedure within the postoperative period.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is appropriate if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
6. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is applicable if an evaluation and management service is provided during the postoperative period that is unrelated to the surgery.
8. Modifier 26 - Professional Component: Use this modifier if only the professional component of the service is being billed.
9. Modifier TC - Technical Component: This modifier is used if only the technical component of the service is being billed.
10. Modifier 59 - Distinct Procedural Service: This modifier is applicable when the procedure is distinct or independent from other services performed on the same day.
It is essential to choose the appropriate modifier(s) based on the specific circumstances surrounding the procedure to ensure accurate billing and compliance with payer requirements.
CPT code 28309 is reimbursed by Medicare, but the 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 and their corresponding reimbursement rates. However, it is important to note that the final determination of reimbursement for CPT code 28309 can also depend on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region. MACs have the authority to interpret national policies and may have additional local coverage determinations (LCDs) that affect whether and how a particular CPT code is reimbursed. Therefore, it is advisable to consult both the MPFS and your specific MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 28309.
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 28309, you can ensure that every dollar is accounted for. Schedule a demo today to see how RevFind can help you maximize your reimbursements and improve your financial performance.
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