ED Coding and Reimbursement Alert

Question: We had a private consulting firm audit our records recently, and they determined that we should be using finger and toe modifiers more often on our claims. Why would we do this if we have other modifiers to use instead?

Codify Subscriber

Answer: Medicare’s rule is that you should use finger/toe modifiers whenever they are necessary to paint the most accurate picture of the patient’s injuries and how they correlate to the provider’s services. Many private payers follow Medicare’s lead on policy, so it’s likely that many of those payers also require the modifiers.

Keep in mind that if the modifier you’re using in place of the finger and toe modifiers is 59 (Distinct procedural service), you may be flagged for overusing it. Modifier 59 is the modifier of last resort, payers say, which means that if a more specific modifier is available, you should use that instead — which can often lead you to bill claim with the finger and toe modifiers instead.

When discussing the fingers, you’ll look to modifiers FA (Left hand, thumb) through F9 (Right hand, fifth digit), and if you’re treating toes, look to modifiers TA (Left foot, great toe) through T9 (Right foot, fifth digit).

Logic: These F/T modifiers serve a serious purpose: Improving patient care. They prevent erroneous denials when duplicate CPT®/HCPCS codes are billed to report separate procedures on different anatomical sites, or different sides of the body.

Also, reporting these modifiers will potentially avoid medical necessity denials in the future, since you are indicating that this is a different finger/toe. Medicare recognizes these modifiers, so most Medicare payers would be familiar with them. As usual, you should check with your private payers for their individual stances on F/T modifiers, since the specificity of ICD-10 will sometimes make it unnecessary for you to use them.