CPT code 28750 is a medical billing code used for the fusion of the big toe joint, helping healthcare providers accurately document and bill for the procedure.
CPT code 28750 is for the surgical procedure involving the fusion of the big toe joint. This procedure is typically performed to alleviate pain and restore stability in cases of severe arthritis or injury affecting the joint. By fusing the bones in the big toe, the procedure aims to improve function and reduce discomfort during activities such as walking or standing.
When billing for the CPT code 28750 (Fusion of big toe joint), 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 procedure is performed on both big toe joints.
2. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left big toe joint.
3. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right big toe joint.
4. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required, justifying additional reimbursement.
5. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier if the procedure is repeated on the same toe joint by the same physician on the same day.
6. Modifier 59 - Distinct Procedural Service: Use this modifier if the procedure is performed separately from other procedures on the same day, indicating that it is distinct or independent.
7. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period.
8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Use this modifier if a different procedure is performed by the same physician during the postoperative period of the original procedure.
9. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Use this modifier if multiple tests are performed on the same day to monitor the patient's condition related to the procedure.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
The CPT code 28750 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 additional requirements, healthcare providers should consult the MPFS.
Additionally, it is essential to verify with the respective Medicare Administrative Contractor (MAC) for any local coverage determinations or specific guidelines that may affect reimbursement for CPT code 28750.
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 28750. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue.
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