CPT code 28730 is a medical billing code used for the surgical fusion of foot bones, helping providers accurately document and bill for the procedure.
CPT code 28730 is the procedure for the fusion of foot bones, specifically indicating a surgical intervention where two or more bones in the foot are permanently joined together. This procedure is typically performed to alleviate pain, improve stability, or correct deformities in the foot. It may involve the use of bone grafts or hardware to ensure proper alignment and healing of the fused bones.
When billing for the CPT code 28730 (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: This modifier is used when the procedure is performed on both feet. It indicates that the fusion was done bilaterally.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if the fusion of foot bones is performed alongside other surgical procedures during the same session.
3. Modifier 58 - Staged or Related Procedure: This modifier is used when 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 appropriate when the fusion is performed separately from other procedures that may be considered part of the same surgical session.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used if the same procedure is performed again on the same foot by the same physician.
6. Modifier 78 - Unplanned Return to the Operating Room: This modifier is applicable if the patient requires an unplanned return to the operating room for complications related to the initial fusion procedure.
7. Modifier 79 - Unrelated Procedure by Same Physician: This modifier is used when a different procedure is performed by the same physician during the postoperative period of the initial fusion.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right foot.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left foot.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist: This modifier is used when the procedure is performed by a non-physician provider 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 28730 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 28730, and can be accessed online for the most current data.
Additionally, your MAC can offer localized guidance and any specific billing requirements or restrictions that may apply to ensure proper reimbursement.
Always consult these resources to confirm the latest reimbursement policies and rates for CPT code 28730.
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, including specific codes like 28730. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
