CPT code 28475 is used to describe the treatment of a metatarsal fracture, detailing the specific procedure performed.
CPT code 28475 is used to describe the treatment of a metatarsal fracture, specifically indicating a surgical procedure that involves the fixation of a fracture in one of the metatarsal bones of the foot. This code typically applies to cases where the fracture requires surgical intervention, such as internal fixation, to ensure proper alignment and healing of the bone.
When billing for CPT code 28475, which pertains to the treatment of a metatarsal fracture, there are several modifiers that 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 if the procedure is performed on the left foot.
3. Modifier RT - Right Side: Use this modifier if the procedure is 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 on the same foot by the same physician.
6. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the procedure is repeated on the same foot by a different physician.
7. Modifier 59 - Distinct Procedural Service: Use this modifier if the procedure is performed in a distinct or separate session from other procedures.
8. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if the procedure involves repeated testing or evaluation.
9. Modifier 52 - Reduced Services: Use this modifier if the procedure was partially reduced or eliminated at the physician's discretion.
10. Modifier 53 - Discontinued Procedure: Use this modifier if the procedure was started but had to be discontinued due to extenuating circumstances.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure performed to ensure accurate billing and compliance with payer requirements.
The CPT code 28475 is reimbursed by Medicare, but it is essential to verify its specific reimbursement rate and coverage details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of fees that Medicare uses to reimburse physicians and other healthcare providers for their services.
Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that may affect the reimbursement of CPT code 28475. Each MAC may have unique policies and procedures, so ensuring compliance with their requirements is crucial for accurate and timely 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, including specific codes like 28475. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue.
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