Podiatry Coding & Billing Alert

Question: I recently performed an open reduction on the first metatarsal head of a patient who has avascular necrosis and smashed her foot against a table, crushing a good portion of the bone. In addition to the open reduction, I needed to use bone paste to reconstruct the metatarsal head and fill in voids, and then applied an external fixation device. How should I code this procedure?

Idaho Subscriber

Answer: Most likely, you will just be able to code 28485 (Open treatment of metatarsal fracture, includes internal fixation, when performed, each) for the entire scenario that you present. Reason: Most carriers will include any reconstruction and use of bone paste as an inherent part of the open reduction.

Other possibility: If you think that the metatarsal head reconstruction involved work considerably greater than that  described in 28485, you may consider appending modifier 22 (Unusual procedural services).

Remember that most payers review modifier 22 claims on a case-by-case basis, so you will need to clearly demonstrate in your documentation that your work or time went significantly beyond what would be typical for open reduction of a metatarsal fracture. For example, if you typically spend 30 minutes treating an open fracture, but reduction with the metatarsal head reconstruction required 70 minutes, modifier 22 would likely be appropriate.

Tip: Don't rely on your payer to increase your procedural fee. Include a letter with your claim that directly states the percentage of your requested fee increase and the reason for it.