CPT code 28315 is for the removal of a sesamoid bone, a small bone located in the foot that can cause pain or discomfort.
CPT code 28315 is for the surgical removal of a sesamoid bone, which is a small bone embedded within a tendon or joint. This procedure typically involves excising the bone to alleviate pain or dysfunction in the foot, particularly in the area of the big toe. It is often performed when conservative treatments have failed to provide relief from conditions such as sesamoiditis or fractures of the sesamoid bone.
When billing for CPT code 28315 (Removal of sesamoid bone), 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 should be applied if the removal of the sesamoid bone is performed in conjunction with other surgical procedures during the same session.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed on a different site or a different session than other procedures billed on the same day.
4. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left foot.
5. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right foot.
6. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
7. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated on the same day by the same physician.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for complications related to the initial procedure.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used if a different procedure is performed during the postoperative period of the initial surgery.
10. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is applicable if an evaluation and management service is provided during the postoperative period that is unrelated to the surgery.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and appropriate reimbursement for healthcare providers.
CPT code 28315 is reimbursed by Medicare, but it is essential to verify the specific details 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 the reimbursement rates. Additionally, MACs administer Medicare claims and can offer region-specific information regarding coverage and reimbursement for CPT code 28315. Therefore, healthcare providers should consult both the MPFS and their respective MAC to ensure accurate and up-to-date information on the reimbursement status of CPT code 28315.
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 28315, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
