CPT code 28485 is used to describe the treatment of a metatarsal fracture, detailing the specific procedure performed.
CPT code 28485 is used to describe the surgical treatment of a metatarsal fracture. This code specifically refers to the procedure of internal fixation of a fracture in one of the metatarsal bones of the foot, which may involve the use of screws, plates, or other devices to stabilize the bone and promote healing. This code is applicable when the fracture is treated surgically, indicating a more complex intervention than conservative management.
When billing for CPT code 28485, 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 or Service 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 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Used when a patient has multiple evaluation and management encounters on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Indicates that a patient returned to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test
Indicates that a laboratory test was repeated on the same day.
It is essential for healthcare providers to select the appropriate modifier(s) based on the specific circumstances of the treatment provided to ensure accurate billing and reimbursement.
The CPT code 28485 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. To determine if CPT code 28485 is reimbursed under the Medicare Physician Fee Schedule (MPFS), healthcare providers should consult the MPFS database, which outlines the payment rates for services covered by Medicare.
Additionally, it is essential to check with the local Medicare Administrative Contractor (MAC) for any region-specific guidelines or coverage determinations that might affect reimbursement. Each MAC may have unique policies or requirements that could influence whether and how CPT code 28485 is reimbursed.
Therefore, verifying with both the MPFS and the appropriate MAC is crucial for accurate and comprehensive reimbursement information.
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 28485. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue.
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