Podiatry Coding & Billing Alert

Question: The podiatrist performed a level-three evaluation and management (E/M) service on an established patient. The podiatrist diagnosed the patient with right-footed acquired hammertoe. The podiatrist then performed a hammertoe correction via total phalangectomy and a capsulotomy for one joint with tenorrhaphy. What CPT^® codes should we report?

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Answer: In this case, you'll most likely report 28285 (Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) for the repair and 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity ...) for the E/M service with modifier 57 (Decision for surgery) appended. Modifier 57 shows the payer that the podiatrist performed the E/M, then he decided to perform the repair based on the E/M results.

Don't miss: A recent CCI Correct Coding Initiative (CCI) 2018 edit now explicitly forbids you from reporting 28270 (Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)) and 28285 for the same patient encounter. According to CCI, 28270 is now a column 2 (component) code to 28285, the column 1 (comprehensive) code.

Caution: Although you may be tempted to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to an E/M preceding 28285, you should not do this. You should only append modifier 25 to significant, separately identifiable E/M services that occur before a minor surgery - one with a global period of 10 days or less. Modifier 57 is the correct modifier for 28285 because the repair code has a global period of 90 days.