Podiatry Coding & Billing Alert

Question: My colleague said that we can’t bill codes 28740 and 29450 together on a claim. Is this true?

South Carolina

Answer: There is a procedure-to-procedure Correct Coding Initiative (CCI) edit between codes 29405 and 28470. Code 29405 is a column 2 code for 28470, meaning that it is bundled into 29405 and you would not normally report both of these codes for a patient on a single date of service.

However, since this PTP edit does have a modifier indicator of “1,” you can overcome this edit, if appropriate, with the use of a modifier, such as modifier 59 or modifiers XE (Separate encounter…), XS (Separate structure…), XP (Separate practitioner…), or XU (Unusual non-overlapping service…).

Caution: You should never use modifier 59 and other CCI-associated modifiers to bypass a CCI edit unless you meet the proper criteria for the use of the modifier. The documentation in the medical record must satisfy the criteria required by any CCI-associated modifier that you use.