CPT code 28735 is a medical billing code used for the surgical fusion of foot bones, helping healthcare providers accurately document procedures.
CPT code 28735 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, alleviate pain, or correct deformities. The fusion can help improve function and reduce discomfort for patients with conditions affecting the foot's structure.
When billing for the CPT code 28735 (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, 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 the 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 22 - Increased Procedural Services
Used when the procedure required significantly more work than typically required.
7. Modifier 76 - Repeat Procedure or Service by Same Physician
Indicates that the same procedure was performed again by the same provider on the same day.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room
Used when a patient requires a return to the operating room for a related procedure within the global period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Indicates that a procedure was performed that is unrelated to the original procedure during the postoperative period.
10. Modifier 92 - Alternative Laboratory Platform Testing
Used when the procedure is performed using an alternative laboratory platform.
These modifiers help provide additional context for the procedure performed and ensure accurate billing and reimbursement. It is essential to select the appropriate modifier(s) based on the specific circumstances surrounding the procedure to avoid claim denials and ensure compliance with payer requirements.
The CPT code 28735 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS).
The MPFS provides a comprehensive list of services covered by Medicare and the corresponding reimbursement rates. Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the local coverage and payment policies for CPT code 28735.
It is essential for healthcare providers to consult both the MPFS and their respective MACs to ensure compliance with Medicare's reimbursement criteria for this specific code.
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 28735, 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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