CPT code 28675 is for the repair of a dislocated toe, detailing the specific procedure for accurate billing and documentation in healthcare.
CPT code 28675 is used to describe the surgical procedure for the repair of a dislocated toe. This code specifically indicates that the healthcare provider has performed a procedure to realign and stabilize the dislocated joint in the toe, ensuring proper function and healing.
When billing for the CPT code 28675, which pertains to the repair 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 repair of the toe dislocation is performed alongside other surgical procedures during the same session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician: This modifier is appropriate if the repair is part of a staged procedure or if it is a subsequent procedure related to the initial treatment.
4. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for complications related to the initial procedure.
5. Modifier 79 - Unrelated Procedure or Service by the Same Physician 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 22 - Increased Procedural Services: This modifier can be used if the complexity of the procedure significantly exceeds the usual level of service, warranting additional reimbursement.
7. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician 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 procedure.
8. Modifier 59 - Distinct Procedural Service: This modifier may be used to indicate that the procedure is distinct or independent from other services performed on the same day.
Each of these modifiers serves to provide additional context for the procedure performed, ensuring accurate billing and reimbursement in the healthcare revenue cycle management process.
The CPT code 28675 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code.
Additionally, it is advisable to consult with your regional Medicare Administrative Contractor (MAC) to confirm the reimbursement status and any specific billing requirements or guidelines that may apply to CPT code 28675. The MACs are responsible for processing Medicare claims and can provide the most accurate and up-to-date information regarding coverage and reimbursement.
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 CPT code 28675, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
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