Podiatry Coding & Billing Alert

Question: The podiatrist performed a level-four evaluation and management (E/M) service for the patient before performing closed treatment of the phalanges without manipulation on the patient's left great toe and closed treatment with manipulation of the phalanx on the patient's left pinky toe. How should I report this?

Nevada Subscriber

Answer: On this claim, you would report the following codes:

• 28490 (Closed treatment of fracture great toe, phalanx or phalanges; without manipulation) for the great toe treatment. Modifiers: If the payer requires it, you should append modifier LT (Left side) to 28490 to indicate laterality. And, if the payer requires it, you should also append modifier TA (Left foot, great toe) to 28490 to specify the surgery area.
• 28515 (Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each) for the pinky toe treatment. Modifiers: If the payer requires it, you should append modifier LT to 28515 to indicate laterality. Additionally, you should append modifier T4 (Left foot, fifth digit) to 28515 to specify the surgery area. And don't forget to append modifier 51 (Multiple procedures) to 28515 to show that the podiatrist performed multiple procedures.
• 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity...) for the E/M service. Modifiers: You should append modifier 57 (Decision for surgery) to 99203 to show that the podiatrist performed a significant, separately identifiable E/M service before treating the patient's fractures.

Caution: There are a lot of potential modifier combinations for this claim. Some payers will want the LT modifiers, others might prefer TA/T4 to indicate treatment area, and others might just want modifier 51. Your payer could also want a different combination involving these three modifiers, or no modifiers at all on the procedure codes. If you have any doubt as to your payer's preference on these modifiers, be sure to contact a rep before filing the claim.

In fact, your payer might only want modifier 57 appended to 99203 and no other modifiers at all on the claim. You need to know what the payer wants, however, before deciding which modifiers to include and leave off the claim.