Wiki mallet finger POS

[NEOSM507]

I am getting frequent denials for closed treatment of mallet finger (26432) when performed in an office setting. I am unable to find a source that states it must be performed in a hospital setting. Aetna cited CMS guidelines, but I am still unable to come up with any policy on it. If anyone can help, I'd appreciate it. Thank you

 

[SharonCollachi]

The first thing I usually do is check the Medicare Fee schedule lookup tool, to see if it is priced for non-facility as well as facility. In this case, both are shown.

Then, I did find that Aetna has a policy on hammertoe, which is also called "mallet toe" (though no policy on mallet finger). Here is that policy. Unless I missed it, that policy does not indicate any required POS.

So, I would ask Aetna for their medical policy on this code, OR the Medicare policy they are relying on, in writing, because according to your sources, there is none.