CPT code 28636 is used to describe the treatment of a dislocated toe, detailing the specific procedure performed by healthcare providers.
CPT code 28636 is used to describe the procedure for treating a dislocation of the toe. This code specifically refers to the manipulation and reduction of the dislocated toe, which may involve realigning the bones and ensuring proper positioning to facilitate healing. It is typically performed by a healthcare provider to restore normal function and alleviate pain associated with the dislocation.
When billing for the CPT code 28636, which pertains to the treatment of a toe dislocation, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both toes simultaneously.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if the procedure is performed in conjunction with other surgical procedures on the same day.
3. Modifier 59 - Distinct Procedural Service: This modifier is appropriate when the procedure is performed separately and is not considered part of another procedure.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated by the same physician on the same day.
5. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is applicable if the patient requires a return to the operating room for a related procedure within the global period.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician: This modifier should be used if a different procedure is performed by the same physician during the global period that is unrelated to the original procedure.
7. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left toe.
8. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right toe.
Each of these modifiers serves to provide additional information about the procedure performed, ensuring accurate billing and compliance with payer requirements.
The CPT code 28636 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 and their respective payment rates. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have localized policies and fee schedules. Therefore, it is advisable to consult the relevant MAC for your area to confirm the exact reimbursement rate and any specific billing requirements for CPT code 28636.
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