Primary Care Coding Alert

Reader Question:

Yes, You Can Sometimes Bill 28470 and 29405 Together

Question: Is it appropriate to bill 28470 with 29405? I don't quite understand what 28470 includes.Vermont Subscriber Answer: The most recent Correct Coding Initiative (CCI) edits classify 29405 (Application of short leg cast [below knee to toes]) as a Column 2 code for 28470 (Closed treatment of metatarsal fracture; without manipulation, each). That means you should not normally report both codes for a single date of service. However, the edits do allow you to append a modifier (usually modifier 59, Distinct procedural service) to 29405 in order to report both services. Ensure that you have documentation supporting two separate services before filing a claim with both codes. Code inclusion: By billing 28470, the physician assumes responsibility for treating the fracture (even if it involves minimal care and risk) and agrees to monitor the fracture's course of healing. Medicare assigns a 90-day follow-up time to 28470, but other payers might differ. [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Primary Care Coding Alert

View All

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.