CPT code 28345 is used to describe the surgical repair of webbed toe(s) in patients, detailing the specific procedure performed.
CPT code 28345 is used to describe the surgical procedure for repairing webbed toe(s). This code specifically indicates that a healthcare provider has performed a corrective surgery to separate and reconstruct the toes that are fused together, a condition known as syndactyly. The procedure aims to improve both the function and appearance of the toes, allowing for better mobility and comfort for the patient.
When billing for CPT code 28345, which pertains to the repair of webbed toe(s), several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used, along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both feet.
2. Modifier 51 - Multiple Procedures
Applied when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service
Indicates that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician
Used when the same procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Indicates that the patient required an unplanned 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
Used when a different procedure is performed by the same physician during the postoperative period of the original procedure.
7. Modifier LT - Left Side
Specifies that the procedure was performed on the left foot.
8. Modifier RT - Right Side
Specifies that the procedure was performed on the right foot.
9. Modifier 22 - Increased Procedural Services
Indicates that the procedure was more complex than usual, warranting additional reimbursement.
10. Modifier 27 - Multiple Encounters on the Same Date
Used when a 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 reimbursement.
CPT code 28345 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 the corresponding reimbursement rates. However, it is essential to verify the coverage and reimbursement details with your local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide region-specific information. Always consult the MPFS and your MAC to ensure compliance and accurate reimbursement for CPT code 28345.
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 28345, 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
