CPT code 28645 is a medical billing code used to describe the procedure for repairing a dislocated toe.
CPT code 28645 is used to describe the surgical procedure for repairing a dislocated toe. This code indicates that a healthcare provider has performed a specific intervention to realign and stabilize the toe joint after it has been dislocated, ensuring proper healing and function.
When billing for the CPT code 28645, which pertains to the repair of a toe 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 toes simultaneously.
2. Modifier 51 - Multiple Procedures: This modifier should be applied if the repair of the toe dislocation is performed alongside other surgical procedures during the same session.
3. Modifier 58 - Staged or Related Procedure or Service: This modifier is appropriate if the repair is part of a staged procedure or if it is a subsequent procedure related to an earlier service.
4. Modifier 78 - Return to the Operating Room for a Related Procedure: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period of the original surgery.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period: This modifier is applicable if a different procedure is performed during the postoperative period that is unrelated to the initial repair.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the repair is repeated on the same toe by the same physician.
7. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required for a standard repair.
8. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period: This modifier is relevant if an evaluation and management service is provided during the postoperative period that is unrelated to the surgical procedure.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and compliance with payer requirements. It is essential to select the appropriate modifier based on the specific circumstances surrounding the procedure to avoid claim denials and ensure proper reimbursement.
The reimbursement of CPT code 28645 by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the Medicare Administrative Contractor (MAC) for your region.
The MPFS is a comprehensive listing of the payment rates used by Medicare to reimburse physicians and other healthcare providers for services rendered. To determine if CPT code 28645 is reimbursed, you would need to consult the MPFS to see if it is listed and what the associated reimbursement rate is.
Additionally, each MAC may have specific local coverage determinations (LCDs) that could affect whether CPT code 28645 is reimbursed. These LCDs provide detailed information on the conditions under which a service is considered medically necessary and, therefore, reimbursable.
It is advisable to check with your regional MAC to confirm the reimbursement status of CPT code 28645 and to ensure compliance with any local coverage requirements.
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