Podiatry Coding & Billing Alert

Question: What factors should we consider about billing 28110 with 28285?

Wisconsin Subscriber

Answer: CPT guidelines consider 28110 (Ostectomy, partial excision, fifth metatarsal head [bunionette] [separate procedure]) as a separate procedure, and there are no CCI edits pertaining to the procedures you mention. AAOS also does not warn of any bundling issues.

Here's what happens: Your physician performs 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) in the proximal interphalangeal joint and 28110 on the metatarsal head. You should be able to report both procedures because they are two separate sites.

Before you file: Because you're coding for both procedures, verify with the carrier whether you should append modifier 59 (Distinct procedural service) to complete your claim.