# Unlisted Procedure for toes???



## anwalden (Mar 3, 2010)

I have another case that's new to me that I was hoping for some clarification on. The doctor wants to code 26531, which is the correct procedure, but for fingers, not toes. He's telling me that since they don't have one for toes, we should use the finger one. The rep that brought the implant says for the 2nd metatarsal head we should be using 28112 with a -22 modifier. I'm relatively sure that -22 is not an ASC approved modifier. Any thoughts?
See the Op note below:


PREOPERATIVE DIAGNOSIS:  Degenerative joint disease with avascular necrosis of the dorsal second metatarsal head of the right foot.  

POSTOPERATIVE DIAGNOSIS:  Degenerative joint disease with avascular necrosis of the dorsal second metatarsal head of the right foot. 

PATHOLOGY:  None.  

PROCEDURE:  Arthroplasty with hemi-joint implant of the right second metatarsophalangeal joint.  

ANESTHESIA:  MAC.  

HEMOSTASIS:  Pneumatic calf tourniquet at 250 mmHg for 17 minutes.   

ESTIMATED BLOOD LOSS:  Minimal.  

COMPLICATIONS:  None.  

CONDITION OF THE PATIENT:  Stable.  

PROCEDURE:  The patient was transferred from the preoperative holding area to the operating room where the patient was placed on the table in the supine position, at which time, the right lower extremity was prepped and draped in the usual sterile technique. 

Attention was directed to the dorsal metatarsophalangeal joint where a linear incision was made medial and parallel to the tendon.  The capsular structure was then incised as well, and the soft tissue was freed off the second metatarsal head.  Next, a guidewire was placed, and confirmed with C-arm, in the medullary canal.  Next, the taper post drill hole was made and the guide hole was also done.  The taper post was placed and noted to be excellent.  The sizing cap was then also placed and noted to be very good.  Next, the metatarsal head was sized and the implant was 1 x 1 x 2 cm.  The second metatarsal cartilage was then prepped.  The reaming prominent cartilage was removed with a rongeur and the implant was then pre-sized and then place.  There was noted to be excellent range of motion with the second metatarsophalangeal joint, as well as placement.  There was no angulated deformity.  

The tourniquet was deflated.  The wound was irrigated.  The capsule was closed with Vicryl, the subcutaneous tissue was closed with Vicryl, and the skin with Prolene.  Sterile dressings were then applied.  The patient was then transferred from the operating room to the PACU with vital signs stable and vascular status intact.  There were no complications encountered on the case. The patient tolerated both the anesthesia and the procdure well.


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## smcbroom (Mar 4, 2010)

you may want to look at code 28293 or 28299?  Your physician is incorrect when he directs you to use a finger CPT code since you could not find one for the toes.  Also, for an ASC we do not use modifier 22 as this is for physician billing.  ASC's don't get paid additional money for the modifier 22 - (increased procedural service).  Also, you should have some implant charges to capture so look at your L86XX codes.

Hope this helps!
Susan


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## anwalden (Mar 4, 2010)

I was thinking 28293 was just for the 1st toe since it's under bunion correction? I suppose I could bill it with a modifier to show it was for the 2nd toe, but I'm thinking they'd likely deny that. I'm curious why you chose 28299? I hadn't even considered that one since it doesn't talk about placing the implant.


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## smcbroom (Mar 9, 2010)

You are correct and I apologize, too many op reports I coded this day and my head was not in the right place about the 28293.

The 28299 would be a last resort if you are unable to find anything else, just make sure to include the op report and implant invoices with your claim.

Have a good day!


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## anwalden (Mar 9, 2010)

Thanks so much for the input! My brain has been fried over this one. For being a 'common' procedure, it's been tough to find much documentation on how to code correctly for it!


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