CPT code 28322 is for the surgical repair of metatarsals, the long bones in the foot, to correct fractures or deformities.
CPT code 28322 is for the surgical repair of metatarsals, which are the long bones in the foot that connect the ankle to the toes. This procedure typically involves addressing fractures or deformities in the metatarsals to restore proper alignment and function. The repair may include techniques such as internal fixation, where hardware is used to stabilize the bones, or other methods to ensure healing and improve mobility for the patient.
When billing for CPT code 28322 (Repair of metatarsals), 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 (bilaterally).
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 or Service by the Same Physician or Other Qualified Health Care Professional: Use this modifier if the repair is part of a staged procedure or if it is a subsequent procedure related to the initial surgery.
4. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure: Use this modifier if a return to the operating room is necessary due to complications or related issues from the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if a different procedure is performed during the postoperative period that is unrelated to the original procedure.
8. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left foot.
9. Modifier RT - Right Side: Use this modifier to specify 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.
The CPT code 28322 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region. Each MAC may have specific guidelines and coverage determinations that could impact whether CPT code 28322 is reimbursed.
Therefore, it is advisable to consult both the MPFS and your local MAC for the most accurate and up-to-date information.
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