Podiatry Coding & Billing Alert

Question: My podiatrist’s notes indicate that they performed closed treatment on a patient’s right great toe fracture without manipulation and closed treatment on a patient’s right pinky toe fracture with manipulation. Which codes and modifiers will I need to correctly code this?

AAPC Forum Participant

Answer: You will need more modifiers than codes to correctly report this encounter. On the claim, report:

• 28515 (Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each) for the pinky toe fix
• Modifier T9 (Right foot, fifth digit) appended to 28515 to indicate laterality
• 28490 (Closed treatment of fracture great toe, phalanx or phalanges; without manipulation) for the great toe fix
• Modifier T5 (Right foot, great toe) appended to 28490 to indicate laterality
• Modifier 59 (Distinct procedural service) or modifier XS (Separate structurem a service that is distinct because it was performed on a separate organ/ structure) appended to 28490 to show that this fracture repair is in a different area (great toe) than 28515 (pinky toe)

This coding might be confusing for several reasons.

Why code the pinky toe first? You’ll report 28515 first because it has higher relative value units (RVUs) than 28490: 4.45 for 28515 and 4.40 for 28490. This is likely because the pinky toe fix required manipulation, while the great toe fix did not. The RVU difference in this case might be negligible, but it’s a good idea to code the highest RVU code first on every claim.

Why no modifier RT? Modifiers T5 and T9 already indicate laterality, so applying modifier RT (Right side) to 28515 or 28490 would be redundant.

Why the choice of 59 or XS? Because coding is payer-dependent, you will use the modifiers preferred by the payer. While modifier 59 is indeed valid, it’s generally recommended to opt for a more specific modifier when one is available and more fitting. In this particular situation, the XS modifier would be a more precise choice. However, it’s always a good practice to consult with your payer to understand their preferred modifiers for distinct procedural services.