CPT code 28495 is used to describe the treatment of a fracture in the big toe, detailing the specific medical procedure performed.
CPT code 28495 is used to describe the treatment of a fracture in the big toe. This code specifically refers to the surgical procedure involved in stabilizing and repairing the fracture, which may include the use of internal fixation devices or other methods to ensure proper healing and alignment of the bone.
When billing for CPT code 28495, which pertains to the treatment of a big toe fracture, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both big toes.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if additional procedures are performed during the same session.
3. Modifier 58 - Staged or Related Procedure: Use this modifier if the procedure is part of a staged treatment plan or if it is a subsequent procedure related to the initial treatment.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the procedure is repeated by the same physician on the same day.
5. Modifier 79 - Unrelated Procedure by Same Physician: Use this modifier if a different procedure is performed by the same physician during the postoperative period of the initial procedure.
6. Modifier 22 - Increased Procedural Services: This modifier can be used if the procedure required significantly more work than typically required.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician: This modifier is appropriate if an evaluation and management service is provided during the postoperative period that is unrelated to the original procedure.
8. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: Use this modifier if multiple evaluation and management services are provided on the same day in an outpatient setting.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and reimbursement in accordance with the specific circumstances of the treatment.
The CPT code 28495 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs may have specific guidelines or requirements for reimbursement, so it is advisable to consult with your local MAC to ensure compliance and accurate billing practices.
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 28495, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and recover lost revenue.
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