Wiki 28298 with 28289

[tobieforte]

I need help! I'm trying to find out if there is a NCCI edit for these two codes. The RVU for CPT code 28298 is 7.75 and the RVU for 28289 is 6.90, so the 28298 is the primary code. I do not see that they are mutually exclusive according to CMS.

Per the OP report, I only see 1 incision that was done longitudinally, posterior medially over the hallux metatarsophalangeal joint where the biplanar dorsal cheilectomy was performed. The osteotomy was performed at the proximal phalanx.

I feel like these two procedures were performed in the same anatomical area. The question is: Should I apply a 51 or a 59 modifier to the 28289?? Please help!

Thank you!

 

[CodingKing]

28298 is a column 2 code to 28289 and listed as mutually exclusive. It does allow modifier if appropriate.

 

[tobieforte]

Thanks for your reply. I'm confused. Where are you looking that the 28298 is the column 2 code?? I am coding for the physician and it has a higher RVU that the 28289.

 

[CodingKing]

Its not uncommon for the bundled procedure to have a higher RVU. In this case the one with the lower RVU will pay and the one higher is mutually exclusive.

[TABLE="width: 675"]
[TR]
[TD]Column 1[/TD]
[TD]Column 2[/TD]
[TD]* = In existence prior to 1996[/TD]
[TD]Effective Date[/TD]
[TD]Deletion Date
*=no data[/TD]
[TD]Modifier
0=not allowed
1=allowed
9=not applicable[/TD]
[TD]PTP Edit Rationale[/TD]
[/TR]
[TR]
[TD]28289[/TD]
[TD]28298[/TD]
[TD][/TD]
[TD]20000605[/TD]
[TD]*[/TD]
[TD]1[/TD]
[TD]Mutually exclusive procedures[/TD]
[/TR]
[/TABLE]

 

[tobieforte]

Well thank you for explaining. It's just very confusing when you are in the habit of considering the higher RVU code column 1. I had checked Code X both ways, and they are not mutually exclusive either way.