CPT code 28800 is for the surgical amputation of the midfoot, detailing the procedure for accurate billing and documentation in healthcare.
CPT code 28800 is used to describe the surgical procedure involving the amputation of the midfoot. This code specifically indicates that the amputation is performed at the level of the midfoot, which includes the bones and soft tissues in that area. It is typically utilized in cases where there is severe injury, infection, or other medical conditions that necessitate the removal of the midfoot to preserve the patient's overall health.
When billing for the CPT code 28800 (Amputation of midfoot), 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 amputation is performed on both feet.
2. Modifier -RT: Right Side
- Use this modifier to indicate that the procedure was performed on the right foot.
3. Modifier -LT: Left Side
- Use this modifier to indicate that the procedure was performed on the left foot.
4. Modifier -59: Distinct Procedural Service
- Use this modifier when the amputation is performed in conjunction with other procedures that are not normally reported together but are appropriate under the circumstances.
5. Modifier -76: Repeat Procedure by Same Physician
- Use this modifier if the procedure is repeated on the same foot by the same physician.
6. 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.
7. Modifier -79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
- Use this modifier if a different procedure is performed during the postoperative period that is unrelated to the original amputation.
8. Modifier -KX: Requirements Met
- Use this modifier to indicate that the services provided meet the requirements of the payer's policy.
9. Modifier -E1, E2, E3, E4: Eyelid Modifiers
- Although not directly applicable to foot procedures, these modifiers are included for completeness. They specify which eyelid is affected and are not relevant for this code.
It is essential to select the appropriate modifier(s) based on the specific details of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 28800 is reimbursed by Medicare, but it is essential to verify the specific details through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including the reimbursement rates for each CPT code. Additionally, MACs may have localized policies or guidelines that could affect reimbursement.
Therefore, it is advisable to consult both the MPFS and your MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 28800.
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 28800, you can ensure that you are receiving the correct reimbursement for your services. Schedule a demo today to see how RevFind can help you identify and address underpayments effectively.
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
