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Mary LeGrand, RN, MA, CCS-P, CPC, a consultant with KarenZupko & Associates, recently discussed three challenges in coding for foot and ankle procedures in an AAOS Now article.
1. Hammertoe repair and bunion procedures. Hammertoe repair (CPT code 28285) is not listed as an inclusive procedure to a hallux valgus correction procedure, but Medicare CCI edit for CPT code 28296 and 28285 requires appending the modifiers to appropriately override the payor edits. The modifier 59 and toe modifier may be appropriate to indicate that the procedures are separate, according to the report. While some payors don't require a modifier, others could require one or both.
2. Capsulotomy with hammertoe repair. For hammertoe repair and capsulotomy, the location of the capsulotomy should be identified. For a capsulotomy on the interphalangeal joint (CPT code 28272), it's included in the hammertoe repair CPT code 28285 because it's on the same toe. Metatarsophalangeal joint capsulotomy for joint contracture (CPT code 28270) is not included in the hammertoe code because it's performed on a different joint.
3. Pediatric contractures, foot deformity and gait abnormality. When possible, report the procedure by using CPT code 27691 on two lines and modifier 50 to only the second code, indicating that the exact procedure was performed on the contralateral side. If a payor requires a single line submission, report the procedure codes and pay close attention to reimbursement to ensure the procedures are reimbursed correctly.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read the article about foot and ankle coding.
Related Articles on Orthopedic Coding:
4 Points on Coding for Knee Injuries and Conditions
AAOS: 6 Coding Tips for Rehabilitative Services
3 Clarifications for Orthopedic Injection Coding
Mary LeGrand, RN, MA, CCS-P, CPC, a consultant with KarenZupko & Associates, recently discussed three challenges in coding for foot and ankle procedures in an AAOS Now article.
1. Hammertoe repair and bunion procedures. Hammertoe repair (CPT code 28285) is not listed as an inclusive procedure to a hallux valgus correction procedure, but Medicare CCI edit for CPT code 28296 and 28285 requires appending the modifiers to appropriately override the payor edits. The modifier 59 and toe modifier may be appropriate to indicate that the procedures are separate, according to the report. While some payors don't require a modifier, others could require one or both.
2. Capsulotomy with hammertoe repair. For hammertoe repair and capsulotomy, the location of the capsulotomy should be identified. For a capsulotomy on the interphalangeal joint (CPT code 28272), it's included in the hammertoe repair CPT code 28285 because it's on the same toe. Metatarsophalangeal joint capsulotomy for joint contracture (CPT code 28270) is not included in the hammertoe code because it's performed on a different joint.
3. Pediatric contractures, foot deformity and gait abnormality. When possible, report the procedure by using CPT code 27691 on two lines and modifier 50 to only the second code, indicating that the exact procedure was performed on the contralateral side. If a payor requires a single line submission, report the procedure codes and pay close attention to reimbursement to ensure the procedures are reimbursed correctly.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read the article about foot and ankle coding.
Related Articles on Orthopedic Coding:
4 Points on Coding for Knee Injuries and Conditions
AAOS: 6 Coding Tips for Rehabilitative Services
3 Clarifications for Orthopedic Injection Coding