CPT code 28630 is used to describe the treatment of a dislocated toe, detailing the specific procedure performed by healthcare providers.
CPT code 28630 is used to describe the procedure for treating a dislocation of the toe. This code encompasses the specific medical interventions performed to realign the dislocated toe and restore its normal function. It typically involves manipulation or reduction of the dislocation, and may also include any necessary stabilization measures to ensure proper healing.
When billing for the CPT code 28630, which pertains to the treatment of a toe dislocation, 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 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician
Used when a subsequent procedure is planned or anticipated during the postoperative period.
4. Modifier 76 - Repeat Procedure or Service by Same Physician
Indicates that the same procedure was performed again on the same day.
5. Modifier 79 - Unrelated Procedure or Service by Same Physician During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
6. Modifier 22 - Increased Procedural Services
Indicates that the procedure required significantly more work than typically required.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period
Used when an evaluation and management service is provided that is unrelated to the procedure performed.
8. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Indicates that multiple evaluation and management services were provided on the same day.
9. Modifier 59 - Distinct Procedural Service
Used to indicate that a procedure is distinct or independent from other services performed on the same day.
10. Modifier RT - Right Side
Indicates that the procedure was performed on the right side of the body.
11. Modifier LT - Left Side
Indicates that the procedure was performed on the left side of the body.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the treatment to ensure accurate billing and compliance with payer requirements.
The CPT code 28630 is reimbursed by Medicare, but it is essential to verify the specific details 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 are responsible for processing Medicare claims and can offer region-specific guidance on coverage and reimbursement policies.
Therefore, while CPT code 28630 is generally reimbursed by Medicare, consulting the MPFS and your MAC will ensure accurate and up-to-date information tailored to your practice's location.
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 28630, ensuring you capture every dollar owed. Schedule a demo today to see how RevFind can streamline your revenue recovery process.
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