CPT code 28705 is a medical billing code used for the fusion of foot bones, helping healthcare providers accurately report and bill for this procedure.
CPT code 28705 is for the surgical procedure involving the fusion of foot bones. This code specifically indicates that a surgeon is performing a procedure to join two or more bones in the foot to stabilize the area, often to alleviate pain or correct deformities. The fusion can help improve function and reduce discomfort in patients with conditions affecting the foot's structure.
When billing for the CPT code 28705 (Fusion of foot bones), 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 fusion procedure is performed on both feet.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple procedures are performed during the same surgical session.
3. Modifier 58 - Staged or Related Procedure or Service by the Same Physician: Use this modifier if the fusion is part of a staged procedure or if it is a subsequent procedure related to a previous surgery.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier should be used if the fusion procedure is repeated by the same physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if a different procedure is performed by the same physician during the postoperative period of the fusion.
8. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left foot.
9. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right foot.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier can be used if the procedure is performed by a non-physician practitioner under the supervision of a physician.
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 28705 is subject to reimbursement by Medicare, but its eligibility and the specific reimbursement amount are determined by the Medicare Physician Fee Schedule (MPFS). The MPFS outlines the payment rates for services provided to Medicare beneficiaries. Additionally, the final decision on whether CPT code 28705 is reimbursed can also depend on the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can provide more detailed information on coverage and reimbursement criteria for this particular CPT code. Therefore, it is essential to consult both the MPFS and your regional MAC to confirm the reimbursement status and amount for CPT code 28705.
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 CPT code 28705, RevFind identifies discrepancies that could be impacting your bottom line. Schedule a demo today to see how our software can help you recover lost revenue and ensure you are being reimbursed correctly.
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