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ED Coding and Reimbursement Alert

Reader Question:

Multiple Toes Call for Modifier -51

Published on Thu Oct 28, 2004

Question: If a patient has four fractured metatarsals on the same foot, should I report code 28470 one time, or four times? The code specifies "each." Should I append any modifiers?

New Mexico Subscriber

Answer: Because code 28470 (Closed treatment of metatarsal fracture; without manipulation, each) does reference "each," you can report it multiple times using modifier -51 (Multiple procedures). Some payers may also require use of the HCPCS level II codes -TA (Left foot, great toe) and -T9 (Right foot, fifth digit) to identify the specific digits involved.

Although reporting each procedure using modifier -51 is correct coding, some practices may not bill for the procedure four times, depending on the relationship between the amount of work the physician performed and the corresponding charges. You may want to find out your practice's perspective on the issue.
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