CPT code 28476 is used to describe the treatment of a metatarsal fracture, detailing the specific procedure performed.
CPT code 28476 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 28476, which pertains to the treatment of a metatarsal fracture, several modifiers may be applicable depending on the specific circumstances of the procedure. Below is a list of potential modifiers that could be used along with the reasons for their application:
1. Modifier 50 - Bilateral Procedure
Used when the procedure is performed on both feet.
2. Modifier LT - Left Side
Indicates that the procedure was performed on the left foot.
3. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot.
4. Modifier 22 - Increased Procedural Services
Used when the procedure requires significantly more work than typically required, justifying additional reimbursement.
5. Modifier 76 - Repeat Procedure by Same Physician
Indicates that the same procedure was performed again by the same physician on the same day.
6. Modifier 59 - Distinct Procedural Service
Used to indicate that the procedure is distinct or independent from other services performed on the same day.
7. Modifier 52 - Reduced Services
Indicates that the service was reduced in complexity or duration, which may affect reimbursement.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Used when a 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
Indicates that a procedure was performed that is unrelated to the original procedure during the postoperative period.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
Used when a laboratory test is repeated on the same day to obtain subsequent results.
It is essential for healthcare providers to assess the specific circumstances of the treatment and select the appropriate modifiers to ensure accurate billing and compliance with payer requirements.
The CPT code 28476 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered by Medicare. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have different policies and guidelines. Therefore, healthcare providers should consult their respective MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 28476.
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