CPT code 29904 is for subtalar arthroscopy with foreign body removal, a procedure to treat ankle issues.
CPT code 29904 is for a subtalar arthroscopy procedure that involves the removal of a foreign body. This code is used when a healthcare provider performs an arthroscopic surgery on the subtalar joint, which is located below the ankle joint, to remove any foreign objects that may be causing pain or complications.
When billing for CPT code 29904 (Subtalar arthrodesis with foreign body removal), 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 sides of the body during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate when multiple procedures are performed during the same surgical session, indicating that the primary procedure is being billed along with additional procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used when the procedure is distinct or independent from other services performed on the same day, indicating that it should be billed separately.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is performed more than once by the same physician on the same day.
5. 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 of the initial surgery.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a different procedure is performed by the same physician during the postoperative period of the initial procedure.
7. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left side of the body.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right side of the body.
9. 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.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required, justifying additional reimbursement.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and reimbursement.
Determining whether CPT code 29904 is reimbursed by Medicare involves consulting the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractor (MAC) for your specific region. The MPFS provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
To ascertain if CPT code 29904 is reimbursed, you would need to check the MPFS database. This can be done by accessing the CMS website or using specialized software that includes MPFS data. Additionally, MACs, which are regional organizations contracted by Medicare to process claims, may have specific guidelines or local coverage determinations (LCDs) that affect the reimbursement status of CPT code 29904.
In summary, to determine if CPT code 29904 is reimbursed by Medicare, you should review the MPFS and consult the relevant MAC for any specific regional guidelines or LCDs that may apply.
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. With RevFind, you can identify discrepancies for specific CPT code 29904, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how our software can streamline your revenue processes and improve your bottom line.
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
