Orthopedic Coding Alert

Question: I need assistance in coding a closed reduction with percutaneous pinning of great toe and fourth toe of the right foot. I know to use 28496-T5 (percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation -right foot, great toe), but what is best for the -T8 (fourth toe)? I am considering 28515-22-T8, 28525-52-T8 or 28899-T8.

Maine Subscriber

Answer: Neither 28515-22-T8 (closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each, -unusual procedural services, -right foot, fourth digit) nor 28525-52-T8 (open treatment of fracture, phalanx or phalanges, other than great toe, with or without internal or external fixation, each, -reduced services, -right foot, fourth digit) nor 28899-T8 (unlisted procedure, foot or toes, -right foot, fourth digit) is clean enough to go through the payer processing system without an adjuster red-flagging it. Essentially, billing with a -22 or -52 modifier or an unlisted code requires a mailed copy of the operative report clearly showing the why behind the billing. Of the three choices available, 28515-22-T8 most closely aligns itself to the procedure performed it was a closed procedure, there was manipulation, and a percutaneous pinning was performed (append -22 for unusual procedural services).