CPT code 28405 is used for billing the treatment of a heel fracture in healthcare settings.
CPT code 28405 is used to describe the treatment of a heel fracture. This code specifically refers to the surgical procedure involved in repairing a fracture of the calcaneus, which is the bone that forms the heel of the foot. The treatment may involve various techniques, including internal fixation, to stabilize the fracture and promote proper healing. This code is essential for healthcare providers to accurately document and bill for the services rendered in managing heel fractures.
When billing for CPT code 28405, which pertains to the treatment of a heel fracture, 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 heels.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier is appropriate if the treatment is part of a staged procedure or if it is a subsequent procedure related to the initial treatment.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is applicable if the procedure is repeated by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier should be used if the patient requires an unplanned return to the operating room for complications related to the initial procedure.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is relevant if a different procedure is performed by the same physician during the postoperative period that is unrelated to the original procedure.
8. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
9. 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 procedure.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: Use this modifier if the patient has multiple outpatient encounters on the same day.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and reimbursement in accordance with the specific circumstances surrounding the treatment of the heel fracture.
The CPT code 28405 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, it is crucial to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific guidelines that may affect reimbursement for CPT code 28405. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies in your area.
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 28405, you can ensure that every dollar is accounted for. Schedule a demo today to see how RevFind can help you maximize your reimbursements and streamline your financial processes.
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