CPT code 28445 is used to describe the treatment of an ankle fracture, detailing the specific procedure performed by healthcare providers.
CPT code 28445 is used to describe the surgical procedure for treating an ankle fracture. This code specifically refers to the open treatment of a fracture of the distal fibula, which may involve the use of internal fixation devices such as plates or screws to stabilize the bone and promote proper healing. This procedure is typically performed when the fracture is displaced or unstable, requiring surgical intervention to restore function and alignment to the ankle joint.
When billing for CPT code 28445, 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 51 - Multiple Procedures: This modifier should be applied if multiple procedures are performed during the same session, including the treatment of the ankle fracture.
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 a return to the operating room for a related procedure within the global period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier is appropriate if a different procedure unrelated to the original treatment is performed by the same physician during the global period.
8. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required for the treatment of an ankle fracture.
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 global period that is unrelated to the procedure.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: This modifier can be used if multiple outpatient evaluation and management encounters occur 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 28445 is reimbursed by Medicare, but it is essential to verify the specific reimbursement rate and coverage details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective 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 apply to CPT code 28445. The MACs are responsible for processing Medicare claims and can provide detailed guidance on the reimbursement policies for this specific code.
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 28445, 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.
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