CPT code 28635 is used to describe the treatment of a toe dislocation, detailing the specific procedure performed by healthcare providers.
CPT code 28635 is used to describe the procedure for treating a dislocation of the toe. This code specifically refers to the surgical intervention required to realign the dislocated joint and stabilize it, ensuring proper healing and function of the toe.
When billing for the CPT code 28635, 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 toes simultaneously.
2. Modifier 51 - Multiple Procedures
Indicates that multiple procedures were performed during the same session, which may affect reimbursement.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional
Utilized when a subsequent procedure is planned or anticipated during the postoperative period.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Applied when the same procedure is performed again on the same day by the same provider.
5. Modifier 79 - Unrelated Procedure or Service by Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Indicates that a procedure unrelated to the original procedure was performed during the postoperative period.
6. Modifier 22 - Increased Procedural Services
Used when the work required to provide a service is substantially greater than typically required.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
Indicates that an evaluation and management service was provided that is unrelated to the original procedure during the postoperative period.
8. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date
Used when 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 appropriate reimbursement. It is essential for healthcare providers to select the correct modifiers based on the specific circumstances of the treatment to avoid claim denials and ensure compliance with payer requirements.
The CPT code 28635 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the corresponding payment rates.
Additionally, it is advisable to consult with your local Medicare Administrative Contractor (MAC) to confirm any regional variations or specific billing requirements that may apply to CPT code 28635. The MACs are responsible for processing Medicare claims and can provide detailed guidance on coverage and reimbursement policies.
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 the ability to identify discrepancies for specific codes like 28635, you can ensure that your practice is receiving the full reimbursement it deserves. Schedule a demo today to see how RevFind can streamline your revenue processes and improve your bottom line.
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