CPT code 28665 is used to describe the treatment of a dislocated toe, detailing the specific procedure performed by healthcare providers.
CPT code 28665 is used to describe the procedure for treating a dislocation of the toe. This code specifically refers to the manipulation and stabilization of the dislocated toe joint, which may involve realigning the bones and ensuring proper positioning to facilitate healing. This procedure is typically performed by a healthcare provider to restore normal function and alleviate pain associated with the dislocation.
When billing for the CPT code 28665, 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 59 - Distinct Procedural Service
Used to indicate that a procedure is distinct or independent from other services performed on the same day.
4. Modifier LT - Left Side
Indicates that the procedure was performed on the left foot.
5. Modifier RT - Right Side
Indicates that the procedure was performed on the right foot.
6. Modifier 76 - Repeat Procedure by Same Physician
Used when the same procedure is performed more than once by the same physician on the same day.
7. Modifier 78 - Unplanned Return to the Operating Room
Indicates that a patient returned to the operating room for a related procedure during the postoperative period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Used when a procedure is performed that is unrelated to the original procedure during the postoperative period.
9. Modifier 22 - Increased Procedural Services
Indicates that the procedure required significantly more work than typically required.
10. 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 original procedure during the postoperative period.
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 28665 is reimbursed by Medicare, but the reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). To determine the exact reimbursement rate and any applicable guidelines, healthcare providers should consult the MPFS, which provides detailed information on the payment rates for services covered by Medicare.
Additionally, it is essential to verify with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 28665.
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. For instance, with RevFind, you can identify discrepancies related to CPT code 28665, 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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