CPT code 28805 is used to describe the surgical procedure of amputation through the metatarsal bones in the foot.
CPT code 28805 is used to describe the surgical procedure of amputation through the metatarsal bones of the foot. This code specifically indicates that the amputation is performed at the level of the metatarsals, which are the long bones in the middle part of the foot, typically due to conditions such as severe injury, infection, or other medical issues that necessitate the removal of part of the foot.
When billing for CPT code 28805 (Amputation thru metatarsal), 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 -LT: Left Side
- Use this modifier to indicate that the procedure was performed on the left foot.
3. Modifier -RT: Right Side
- Use this modifier to indicate that the procedure was performed on the right foot.
4. Modifier -59: Distinct Procedural Service
- Use this modifier when the procedure is performed separately from other procedures on the same day, indicating that it is not part of a bundled service.
5. Modifier -76: Repeat Procedure by Same Physician
- Use this modifier if the same procedure is performed more than once by the same physician on the same day.
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 by the same physician during the postoperative period of the initial procedure.
8. Modifier -XU: Unusual Non-Overlapping Service
- Use this modifier to indicate that the service is distinct or independent from other services performed on the same day.
These modifiers help clarify the specifics of the procedure and ensure accurate billing and reimbursement. Always verify the appropriateness of each modifier based on the specific clinical scenario and payer guidelines.
CPT code 28805 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 28805. However, the final determination of reimbursement is often made by the Medicare Administrative Contractor (MAC) for your specific region. MACs are responsible for processing Medicare claims and can provide detailed information on coverage policies and reimbursement rates for CPT code 28805. It is advisable to consult the MPFS and your regional MAC to get the most accurate and up-to-date information regarding the reimbursement of this 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 CPT code 28805, you can ensure that every dollar is accounted for. Schedule a demo today to see how RevFind can help you maximize your reimbursements and streamline your financial processes.
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