Podiatry Coding & Billing Alert
Resort to Modifier 59 for Justified Unbundling of Foot Procedures
Question: Our podiatrist's op report states that he performed a bunion correction on the left foot of a patient using a McBride type procedure. After that, he also removed a ganglion cyst that was over the sinus tarsi area of the patient's foot. How should we report the procedures? What is a McBride procedure? Missouri Subscriber Answer: You can report the bunion (hallux valgus) correction with CPT® code 28292 (Correction, hallux valgus [bunion], with or without sesamoidectomy; Keller, McBride, or Mayo type procedure) along with modifier LT (Left foot). In this procedure, the physician treats a bunion (an enlarged bump on the side of the foot) to reduce symptoms, restore function, and correct the deformity. For the cyst removal, you should report code 28090 (Excision of lesion, tendon, tendon sheath, or capsule [including synovectomy] [eg, cyst or ganglion]; foot) along with modifier LT (Left foot). In such a procedure, the physician excises any lesion or cyst affecting the tendon, tendon sheath, or capsule, and may perform a synovectomy, removing the inflamed or diseased synovium from the extensor tendon sheath of the foot to relieve pain. As code 28090 is a column 2 code for 28292 according to CCI edits (both codes are bundled), the payer will only pay for column 1 code 28292. In order to differentiate between the services provided, i.e. to break the bundling and bill both, you should use modifier 59 (Distinct procedural service) with code 28090 (column 2 code only). However, report both codes after making sure that the medical documentation supports reporting of both as individual procedures. In a McBride type procedure, the provider enables a release of soft tissues by removing the bony bump (bunion) and performing a soft tissue release to realign the great toe. The physician would normally chose this type of procedure for early bunion development, but soft tissue procedures do not provide the same sort of correction as do procedures involving bone cuts (known as osteotomies).
Podiatry Coding & Billing Alert
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Resort to Modifier 59 for Justified Unbundling of Foot Procedures
Question: Our podiatrist's op report states that he performed a bunion correction on the left foot [...]
