CPT code 28456 is used to describe the treatment of a midfoot fracture in medical billing and coding.
CPT code 28456 is used to describe the surgical treatment of a midfoot fracture. This code specifically refers to the procedure involving the stabilization and repair of fractures located in the midfoot region, which includes the bones between the hindfoot and forefoot. The procedure may involve the use of internal fixation devices to ensure proper alignment and healing of the fractured bones.
When billing for CPT code 28456, which pertains to the treatment of a midfoot 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 feet.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: Use this modifier if the procedure is part of a staged treatment plan or if it is a subsequent procedure related to the initial treatment.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is appropriate if the patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure by Same Physician: Use this modifier if a different procedure is performed by the same physician during the global period that is unrelated to the original procedure.
7. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
9. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
10. Modifier 27 - Multiple Encounters on the Same Date: This modifier is applicable if the patient has multiple encounters on the same day that involve different procedures.
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 28456 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, and it is updated annually to reflect changes in policy and pricing.
Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) are responsible for processing claims and setting local coverage determinations. Therefore, it is advisable to consult the relevant MAC for your area to obtain precise information on the reimbursement for CPT code 28456.
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