CPT code 28470 is used to describe the treatment of a metatarsal fracture, detailing the specific procedure performed.
CPT code 28470 is used to describe the treatment of a metatarsal fracture, specifically indicating a surgical procedure that involves the stabilization of a broken metatarsal bone in the foot. This code is typically applied when a healthcare provider performs an open reduction and internal fixation (ORIF) to realign the fractured bone and secure it with hardware, such as plates or screws, to promote proper healing and restore function.
When billing for CPT code 28470, which pertains to the treatment of a metatarsal 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: Use this modifier to indicate that the procedure was performed on the left foot.
3. Modifier RT - Right Side: Use this modifier to indicate that the procedure was performed on the right foot.
4. Modifier 22 - Increased Procedural Services: Use this modifier 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: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
7. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
8. 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.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if a different procedure is performed by the same physician during the postoperative period of the original procedure.
These modifiers help provide additional context for the services rendered and ensure accurate billing and reimbursement for the treatment of metatarsal fractures. Always verify the specific requirements and guidelines for modifiers with the relevant payer to ensure compliance.
The CPT code 28470 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding reimbursement rates. However, the final determination of whether CPT code 28470 is reimbursed can also depend on the local coverage decisions made by the Medicare Administrative Contractor (MAC) for your region. MACs have the authority to establish local policies and guidelines that may affect the reimbursement of certain CPT codes. Therefore, it is essential to consult both the MPFS and your regional MAC to confirm the reimbursement status of CPT code 28470.
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, including specific codes like 28470. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
