# New to ortho coding?



## davisph (Nov 2, 2011)

Can anyone advise on code 26600 can you bill this more than once on two separate fingers (f8 & f9) or can it only be one code since the description is stating "metacarpal"? 

Thanks for your help!!

Phyllis D


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## freemacl47 (Nov 2, 2011)

If you read the descriptor in the cpt book, it does state *each bone*.  So yes you can.  If both the fractures require separate xrays and separate castings etc...we would charge out the two codes, but if it doesnt we stick to the one code.


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## MMadrigal (Nov 4, 2011)

Yes, you can code for each Metacarpal fx,  code 26600 with either RT or LT modifier, no f8 or f9, and 2 units.    26600 is not to be used for "finger" fractures.   You can also bill for your fiberglass material.  Mary


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## mitchellde (Nov 4, 2011)

Metacarpal can be billed using the F modifiers because each metacarpal identifies to a unique finger there are 5 metacarpals in each normal hand. so yes if the code states metacarpal then it is for only one bone and you did the 4th and the 5th metacarpal on the right hand which is F8 and F9.


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## armen (Nov 4, 2011)

mitchellde said:


> Metacarpal can be billed using the F modifiers because each metacarpal identifies to a unique finger there are 5 metacarpals in each normal hand. so yes if the code states metacarpal then it is for only one bone and you did the 4th and the 5th metacarpal on the right hand which is F8 and F9.



F modifiers are fore fingers only, same way as T modifiers are for toes. So the right way will be to use RT & LT modifiers for any bones except toes and finger.


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## mitchellde (Nov 4, 2011)

a metacapal is a finger bone!  the finger bones do not start at the apendage the start from the carpal bones.  metatarsals are toe bones!  you do not use LT and RT for metatcarpal you use RT and LT for carpal and tarsal bones but the metacarpals and metatarsal you have 10 of each.  please get a hand and foot skeleton to verify this.  From the hand dictionary:
You have five metacarpal bones, one for each of your fingers.


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## armen (Nov 15, 2011)

mitchellde said:


> a metacapal is a finger bone!  the finger bones do not start at the apendage the start from the carpal bones.  metatarsals are toe bones!  you do not use LT and RT for metatcarpal you use RT and LT for carpal and tarsal bones but the metacarpals and metatarsal you have 10 of each.  please get a hand and foot skeleton to verify this.  From the hand dictionary:
> You have five metacarpal bones, one for each of your fingers.



There are 5 bones called metatarsals located between the proximal phalanges and the distal row of tarsal bones in the hindfoot: 1st, 2nd, 3rd, 4th and 5th metatarsals. 

You should not append toe modifiers (-TA through -T9) to CPT codes that classify metatarsal surgery because metatarsal bones are foot bones, they are not toe bones/phalanges. 

I would be happy to read any written material stating that phalanges include metatarsals & metacarpals. Can you send me a link?


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## mitchellde (Nov 15, 2011)

arme2783 said:


> There are 5 bones called metatarsals located between the proximal phalanges and the distal row of tarsal bones in the hindfoot: 1st, 2nd, 3rd, 4th and 5th metatarsals.
> 
> You should not append toe modifiers (-TA through -T9) to CPT codes that classify metatarsal surgery because metatarsal bones are foot bones, they are not toe bones/phalanges.
> 
> I would be happy to read any written material stating that phalanges include metatarsals & metacarpals. Can you send me a link?



Go to any anatomy book.  The phalange is the distal end of the finger, the finger bone goes from the tip to the wrist, you have 10 distinct metacarpal bones and 10 metatarsals these are fingers and toes, go look at any skeletal film


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## armen (Dec 19, 2011)

mitchellde said:


> Go to any anatomy book.  The phalange is the distal end of the finger, the finger bone goes from the tip to the wrist, you have 10 distinct metacarpal bones and 10 metatarsals these are fingers and toes, go look at any skeletal film



Just talked to my doctor, board certified hand surgeon. He confirmed that fingers do not start from the wrist, metacarpal bones are not fingers. I dont think it makes any difference to you, I just wanted to share this with others.


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## mitchellde (Dec 19, 2011)

I am not sure how you presented the question to him and that would maybe be the reason the answer is the way it is.  When you say fingers you are talking phalanges which are an extension of the metacarpal, but for the purpose of coding you do use the F modifiers for the metacarpal bones, it is all one thing.  If you use only LT and RT for metacarpal procedures and the codes specifies each bone then you are leaving out numerous procedures and you do not use units with surgical procedures.  So if you do not want to use the F modifiers then you can use the 59.  I have coded many hand surgeries for the surgeon and the facility and have always used the F modifiers.  
It is all in how you present the information to the physician with respect to the answer you get.


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## armen (Dec 19, 2011)

mitchellde said:


> I am not sure how you presented the question to him and that would maybe be the reason the answer is the way it is.  When you say fingers you are talking phalanges which are an extension of the metacarpal, but for the purpose of coding you do use the F modifiers for the metacarpal bones, it is all one thing.  If you use only LT and RT for metacarpal procedures and the codes specifies each bone then you are leaving out numerous procedures and you do not use units with surgical procedures.  So if you do not want to use the F modifiers then you can use the 59.  I have coded many hand surgeries for the surgeon and the facility and have always used the F modifiers.
> It is all in how you present the information to the physician with respect to the answer you get.



I have asked him a simple question. "does the finger start from the wrist (as you stated in your post) and is the metacarpal bone finger bone"? He said it does not start from the wrist as far as he knows, and he would not consider metacarpal to be a finger. F and T modifiers in their description have word "digit", I would rather use 59, than say metacarpal is a digit. You may be right Im not saying you are wrong, maybe you can post some links to authoritative publications supporting your point of view.


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## mitchellde (Dec 19, 2011)

arme2783 said:


> Just talked to my doctor, board certified hand surgeon. He confirmed that fingers do not start from the wrist, metacarpal bones are not fingers. I dont think it makes any difference to you, I just wanted to share this with others.



I think the issue is the use of the word finger.  You are using the F in the modifier to mean literally finger and not the entire bone  This from the hand book:
The metacarpal bones in the hand connect the bones in the finger to the bones in the wrist. There are 5 metacarpal bones-1 to connect each finger to the wrist. All of the metacarpal bones have the same anatomic structure. Each consists of the base, the shaft, the neck, and the head. The base of the metacarpal bone is the portion that attaches to the bones of the wrist. The shaft is the long, slender portion of the bone. The neck is the portion of the bone that connects the shaft to the head. The head of the metacarpal bone connects the metacarpal bone to the bone of the finger. The head of the metacarpal bones form the knuckle of an enclosed fist. A boxer's fracture involves a break in the neck of the metacarpal. This was described originally in the fracture of the metacarpal bone of the little (small) finger because this is the most common one to break when punching an immovable object.

So from your logic the metacarpals are not fingers, from my logic you use the F modifiers for the metacarpals as there are 5 in each hand that correspond to each finger.


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## armen (Apr 4, 2012)

*Use modifiers correctly*
Billing for foot surgery often requires billing multiple codes because surgeons can perform forefoot, midfoot, and hindfoot procedures in one session. The use of modifiers is important to correctly identify separate procedures.

Level II (HCPCS/National) “T modifiers” are used to identify surgery performed on specific toes and are found at the back of Appendix A in the Current Procedural Terminology (CPT®) book. They only apply to the phalanges and are not used to identify metatarsal work.

This is form AAOS web, decided to share. I assume the same logic is true for metacarpals.

http://www.aaos.org/news/aaosnow/jun09/managing3.asp


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## mitchellde (Apr 4, 2012)

This not the same thing the code they are referencing is a multiple code, 28114 states ALL metatarsal heads, 28113 is 5th metatarsal head, there are separate codes for each metatarsal so they are saying you do not use the T modifiers for this code ... they are correct.  However the original question was for a procedure which referenced EACH bone and in this case you must use a modifier to identify which bone.


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## armen (Apr 4, 2012)

mitchellde said:


> This not the same thing the code they are referencing is a multiple code, 28114 states ALL metatarsal heads, 28113 is 5th metatarsal head, there are separate codes for each metatarsal so they are saying you do not use the T modifiers for this code ... they are correct.  However the original question was for a procedure which referenced EACH bone and in this case you must use a modifier to identify which bone.



This is what they say _"Level II (HCPCS/National) “T modifiers” are used to identify surgery performed on specific toes and are found at the back of Appendix A in the Current Procedural Terminology (CPT®) book. They only apply to the *phalanges *and are *not used to identify metatarsal *work."_ 

I just wanted to share this so others can look up different resource. I respect your openion though


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## waegeled (Jan 29, 2014)

*finger modifiers*

Metacarpal is the hand, we have a left and right. Finger modifiers are used for the interphalangeal joints, not metacarpal/hand cpt codes.



mitchellde said:


> Metacarpal can be billed using the F modifiers because each metacarpal identifies to a unique finger there are 5 metacarpals in each normal hand. so yes if the code states metacarpal then it is for only one bone and you did the 4th and the 5th metacarpal on the right hand which is F8 and F9.


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## dclark7 (Jan 29, 2014)

If the patient has medicare this is all a moot point, medicare will not pay for more than one closed fracture without manipulation.  This is from the NCCI Policy Manual, Chapter 4, Section F, #14: If a _single _cast, strapping, or splint treats multiple closed fractures without manipulation, only one closed fracture _treatment _without manipulation CPT code may be reported. _Additionally, if a single cast, strapping, or splint treats multiple fractures without manipulation in addition to one or more fracture(s) with manipulation, a closed fracture without manipulation CPT code should not be reported separately. These policies also apply to the closed treatment of multiple fractures not requiring application of a cast, strapping, or splint. _
_If a cast, strapping, or splint applied after an open or percutaneous treatment of a fracture also treats a closed fracture without manipulation, a closed fracture without manipulation CPT code should not be reported separately._


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## stilian77 (Jul 31, 2014)

*billing of closed treatment of metatarsal fracture*

Hello,

Can someone help me with billing problem? I had 3 medial metatarsal bones fractured on my right foot. The doctor took an X-Ray prescribed me a boot and charged me 3 x $ 580. Is this normal ? I did not have any manipulation and charging me 3 times for the same treatment? I saw that medicare does not allow 3 times closed treatment charged for the same procedure. I was charged for the  initial visit, boot,X-Ray and 3x closed treatments. What would be my best response. So far I have appealed with BCBS of Illinois, but I am still waiting for decision. Thank you.


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## amicotaylor (Aug 1, 2014)

You should really only bill one of the fractures according to CMS, "If a single cast, strapping or splint treats multiple closed fx, w/o manipulations, one can be reported". Also would not use digit modifiers for metacarpals, only L/R.


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