CPT code 28340 is a medical billing code used to describe the procedure of resecting enlarged tissue in the toe.
CPT code 28340 is used to describe the surgical procedure of resecting or removing enlarged tissue from the toe. This procedure is typically performed to alleviate pain, improve function, or address deformities caused by conditions such as bunions or other soft tissue abnormalities.
When billing for the CPT code 28340, there are several modifiers that 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 procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
4. 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.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is appropriate if the patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if a different procedure is performed by the same physician during the postoperative period of the original procedure.
7. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
9. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is applicable if the patient has multiple encounters on the same date of service.
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 28340 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should consult the MPFS.
Additionally, it is important to verify with the local Medicare Administrative Contractor (MAC) for any regional variations or additional requirements that may affect reimbursement for CPT code 28340.
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