CPT code 28430 is a medical billing code used for the treatment of an ankle fracture, helping healthcare providers document and bill for services.
CPT code 28430 is used to describe the treatment of an ankle fracture. This code specifically refers to the surgical procedure involved in stabilizing and repairing a fractured ankle, which may include the use of internal fixation devices such as screws or plates to ensure proper alignment and healing of the bone. This procedure is typically performed when the fracture is displaced or unstable, requiring intervention to restore function and mobility to the patient.
When billing for CPT code 28430, which pertains to the treatment of an ankle fracture, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both ankles.
2. Modifier LT - Left Side
Indicates that the procedure was performed on the left ankle.
3. Modifier RT - Right Side
Indicates that the procedure was performed on the right ankle.
4. Modifier 22 - Increased Procedural Services
Used when the procedure required significantly more work than typically required, justifying additional reimbursement.
5. Modifier 76 - Repeat Procedure by Same Physician
Indicates that the same procedure was performed again by the same physician on the same day.
6. Modifier 59 - Distinct Procedural Service
Used to indicate that the procedure is distinct or independent from other services performed on the same day.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
Used when the same test is performed multiple times on the same day, though this is less common for surgical procedures.
8. Modifier 52 - Reduced Services
Indicates that the service was reduced or eliminated at the physician's discretion.
9. Modifier 53 - Discontinued Procedure
Used when a procedure is terminated due to extenuating circumstances or the patient's condition.
10. Modifier 33 - Preventive Services
Indicates that the service provided was preventive in nature, which may apply in certain contexts.
It is essential for healthcare providers to select the appropriate modifier(s) based on the specific circumstances of the treatment provided to ensure accurate billing and reimbursement.
CPT code 28430 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if this particular CPT code is covered under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare. Additionally, it is essential to check with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and any local coverage determinations (LCDs) that might affect reimbursement.
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