CPT code 28605 is used to describe the treatment of a foot dislocation, detailing the specific procedure performed by healthcare providers.
CPT code 28605 is used to describe the surgical procedure for treating a dislocation of the foot. This code specifically refers to the manipulation and stabilization of the dislocated joint, which may involve realigning the bones and ensuring proper positioning to facilitate healing and restore function.
When billing for the CPT code 28605, which pertains to the treatment of foot dislocation, 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 during the same session.
2. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed separately from other procedures on the same day, indicating that it is not a part of a bundled service.
3. Modifier LT - Left Side: Use this modifier when the procedure is performed on the left foot.
4. Modifier RT - Right Side: Use this modifier when the procedure is performed on the right foot.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the procedure is repeated by the same physician on the same day.
6. Modifier 77 - Repeat Procedure by Another Physician: This modifier is applicable if the procedure is repeated by a different physician on the same day.
7. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required, justifying additional reimbursement.
8. Modifier 52 - Reduced Services: This modifier can be used if the procedure was partially reduced or eliminated at the physician's discretion.
9. Modifier 53 - Discontinued Procedure: This modifier is appropriate if the procedure was started but had to be discontinued due to extenuating circumstances.
10. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used if the procedure involves laboratory tests that are repeated on the same day.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 28605 is reimbursed by Medicare, but it is essential to verify its inclusion in the Medicare Physician Fee Schedule (MPFS) to determine the specific reimbursement rate. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding payment amounts.
Additionally, it is crucial to consult with your regional Medicare Administrative Contractor (MAC) as they are responsible for processing Medicare claims and can provide detailed information on coverage policies and any potential local variations in reimbursement.
Always ensure that the service meets Medicare's medical necessity criteria and proper documentation is maintained to support the claim.
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. With RevFind, you can identify discrepancies for specific codes like 28605, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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