Open up your sesamoid coding options with these 3 tips. Coding for hammertoe correction and sesamoid planing separately can be complicated enough, but when the podiatrist has to combine the procedures, it can leave even the most experienced coders bewildered. Follow our experts' three steps below to help solve the following scenario: The podiatrist at a practice sees a patient -- with history of chronic sesamoiditis (733.99) of the right metatarsophalangeal joint and hammertoe (right third and fourth toes) -- for hammertoe correction and sesamoid planing of the metatarsophalangeal joint. The operative report indicates that only 40-50 percent of the sesamoid bone was removed. What should you report? 1. Record Medical Necessity Cosmetic surgery for the purpose of enhancing the appearance of the foot will not give you coverage in most insurance programs. Support medical necessity with: 2. Check for Repair Code Series and T Modifiers Because the podiatrist is doing repair/revision on two of the patient's right toes, you should bill twice using 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]), and 28315 (Sesamoidectomy, first toe [separate procedure]) for the removal of a sesamoid bone performed. Don't forget to append proper T modifiers. Quick fact: Your billing for the scenario given should look like this: "You would probably use the RT modifier with 28315, and not the T5 modifier unless this is an interphalangeal sesamoid of the first toe and not a sesamoid under the 1sr metatarsal head," notes Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va., referring to the last line of what your report should look like. Using modifiers is important to correctly identify various separate procedures, as in the case of foot surgery, which usually requires the use of multiple codes because your podiatrist can perform can perform forefoot, midfoot, and hindfoot procedures in one session. T modifiers are classified level II by HCPCS, and are used to identify surgery performed on specific toes. TA is used for the left hallux, T1 for the second left, T2 for the third left, T3 for the fourth left, T4 for the fifth left, T5 for the right hallux, T6 for the second right, T7 for the third right, T8 for the fourth right, and T9 for the fifth right. Caution: You should always check your CPT® manual to discern if you have a more appropriate choice before you append 52. Optional: "When another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used," according to a National Correct Coding Initiative (NCCI) article. 3. Look Out for Postoperative Services If you're going to report postoperative services, you must report it accurately. Sesamoidectomy and correction of hammertoes classify as major surgical procedures with 90- day global periods. This means that you should not report separately any postoperative fixation (e.g., splint, toe strapping, wires) applied during the global period. Complication: