CPT code 28435 is a medical billing code used for the treatment of an ankle fracture, detailing the specific procedure performed.
CPT code 28435 is used to describe the treatment of an ankle fracture. This code specifically refers to the surgical procedure for the repair of a fractured ankle, which may involve the use of internal fixation devices such as screws or plates to stabilize the bone and promote healing. It is typically utilized when the fracture is displaced or requires surgical intervention to restore proper alignment and function of the ankle joint.
When billing for CPT code 28435, which pertains to the treatment of an ankle 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 ankles during the same session.
2. Modifier LT - Left Side: This modifier is used to indicate that the procedure was performed on the left ankle.
3. Modifier RT - Right Side: This modifier is used to indicate that the procedure was performed on the right ankle.
4. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated on the same ankle by the same physician on the same day.
6. Modifier 59 - Distinct Procedural Service: This modifier is applicable when the procedure is performed separately from other procedures on the same day, indicating that it is not a bundled service.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used if the procedure is performed multiple times on the same day for diagnostic purposes.
8. Modifier 52 - Reduced Services: This modifier may be used if the procedure was partially reduced or eliminated at the physician's discretion.
9. Modifier 53 - Discontinued Procedure: This modifier is applicable if the procedure was started but had to be discontinued due to extenuating circumstances.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: This modifier may be used if the patient had multiple evaluation and management encounters on the same day related to the ankle fracture.
It is essential to choose the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and reimbursement.
The CPT code 28435 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 regional Medicare Administrative Contractor (MAC) to confirm any local coverage determinations or specific billing requirements that may affect reimbursement for CPT code 28435. Each MAC may have unique guidelines and policies, so ensuring compliance with their directives is vital for successful reimbursement.
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. With RevFind, you can identify discrepancies for specific codes like 28435, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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