CPT code 29905 is for subtalar arthroscopy with excision, used to describe a specific surgical procedure in healthcare billing.
CPT code 29905 is for a subtalar arthroscopy with excision. This procedure involves the use of a small camera and instruments inserted into the subtalar joint, which is located below the ankle joint, to visualize and remove any damaged tissue or bone. It is typically performed to address issues such as chronic pain or instability in the subtalar joint, often resulting from conditions like arthritis or previous injuries.
When billing for CPT code 29905 (Subtalar arthrodesis with excision), 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.
2. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same session, indicating that the primary procedure is being billed along with additional procedures.
3. Modifier 58 - Staged or Related Procedure or Service: This modifier should be used if the procedure is a staged procedure or if it is related to a previous procedure performed during the same surgical session.
4. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure is distinct or independent from other services performed on the same day.
5. Modifier 76 - Repeat Procedure by Same Physician: This modifier is appropriate when the same procedure is performed again 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: This modifier is applicable when a procedure is performed that is unrelated to the original procedure during the global period.
8. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right side of the body.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left side of the body.
10. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier is used when the service is performed by a non-physician practitioner.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 29905 is reimbursed by Medicare, but it is essential to verify its specific reimbursement status through the Medicare Physician Fee Schedule (MPFS). The MPFS provides detailed information on the payment rates for services covered under Medicare Part B.
Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) that services your geographic region. Each MAC may have specific guidelines and coverage determinations that impact whether and how a particular CPT code, such as 29905, is reimbursed.
Therefore, it is advisable to consult both the MPFS and your local MAC for the most accurate and up-to-date information.
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