Wiki 28470 with 27822

[JYSPA]

Physician does open left ankle (trimalleolar fracture) ORIF. CPT 27822. He also states that he does closed treatment for left 2-4 metatarsal fractures. CPT 28470. This is a Medicare patient. There is NCCI that closed fracture treatment is included if open treatment done in same area. I’d like to make sure if CPT 28470 can or cannot be billed.. Any opinion on this is appreciated. Thank you.

 

[amyjph]

It depends on how the metatarsal fractures were treated. Was it with the same boot/brace/shoe that may have been applied to the ankle following the ORIF? In that case it would be included. I think this language in the manual applies is: If a cast, strapping or splint applied after an open or percutaneous treatment of a fracture also treats a closed fracture without manipulation, a closed fracture without manipulation CPT code shall not be reported separately. It comes down to if they manipulated or not and how it was treated.
The two codes don't have a conflict per the edits but they might due to the guidelines. It depends on the specifics of the documentation.

 

[JYSPA]

Thank you. The physician did not manipulate the fracture. He did a separate treatment plan for the metatarsal fracture closed treatment without reduction..