CPT code 28465 is used to describe the treatment of a midfoot fracture in each foot, detailing the specific medical procedure performed.
CPT code 28465 is used to describe the treatment of a midfoot fracture in each foot. This code specifically refers to the surgical procedure involved in addressing fractures located in the midfoot region, which includes the bones between the hindfoot and forefoot. The code indicates that the procedure is performed on each affected midfoot, allowing healthcare providers to accurately document and bill for the treatment provided.
When billing for CPT code 28465, 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 LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
3. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
4. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated 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.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier may be used if the procedure is repeated for diagnostic purposes.
8. Modifier 52 - Reduced Services: This modifier can be used if the service provided is less than what is typically required for the procedure.
9. Modifier 53 - Discontinued Procedure: This modifier is applicable if the procedure was started but not completed due to extenuating circumstances.
10. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period.
Each of these modifiers serves to provide additional context to the billing process, ensuring accurate representation of the services rendered and facilitating appropriate reimbursement.
The CPT code 28465 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 28465. The MACs are responsible for processing Medicare claims and can provide detailed information on coverage and payment policies specific to your geographic 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 28465, RevFind identifies discrepancies that could be impacting your bottom line. Schedule a demo today to see how our software can help you recover lost revenue and optimize your financial performance.
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