Wiki Multiple toe fractures

Create Wiki
A

algates21

Guest
Messages
5
Location
Gladstone, MO
Best answers
0
We had a patient come in with each toe, minus small toe, fractured. Doc coded it as 28470 with each toe modifier, TA, T1, T2, T3 and 59s on 3 of them. BCBS denied all of the fx codes. Any idea if this was billed incorrectly or how I fix it?
 
Multiple issues could be going on depending on what actually happened/documentation.
Agree as above, 28470 is metatarsal and the T mods would not make sense either. If it was MT, there are MUE limits per day for the code.
Further, depending on the treatment, according to NCCI, you can only report one unit if the same treatment (cast, splint, strap, post-op shoe, etc.) is used to treat all of them. CPT 28470 is actually the example in the manual. (LoL) https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-4.pdf
"9. A provider/supplier may only report one unit of service of a CPT code describing closed treatment without manipulation of fracture if the same treatment (e.g., cast, splint,strapping) treats fractures of multiple similar bones. For example, if a cast is applied without manipulation to treat fractures of multiple metatarsals of the same foot, only one unit of service of CPT code 28470 may be reported for that treatment. If no cast, splint, or strapping is used for closed treatment without manipulation of multiple similar bones, only one unit of service may be reported for the applicable code."
If it was the phalanges, there are different closed treatment codes for great toe and other toes with/without manipulation.

Why do providers need coders? ;)
 
You must log in or register to reply here.
Top