Wiki Use of CPT code 28232 with hammertoe surgery

[Dkjackso]

I have a physician who always does a flexor tenotomy (28232) with hammertoe surgery. CPT code description in Optum for hammertoes (28285) only discusses extensor tenotomy. Everyone I have asked just says "tenotomy is always included with 28285." This physician does a separate paragraph for flexor tenotomy, makes a separate incision (although same toe(s), of course). Encoder says 28285 and 28232 can be billed together with a modifier. Is FLEXOR tenotomy appropriate to bill, or is it included in code 28285? I am new to Podiatry coding and really am looking to do this correctly. Any clarity at all here is greatly appreciated!

 

[Orthocoderpgu]

Have you checked the NCCI edits between these two codes? If so, what did you find out?

 

[podcoder70]

The tenotomy is included with "hammertoe correction" 28285. What will get "paid" with modifiers and what is appropriate are sometimes two different things. According to the APMA the tenotomy (flexor or extensor) is included. The CCI edits show 28232 as column 2 with 28285 with indicator 1, which means it can be billed and paid with 59 modifier. However, the code 28232 is defined as "separate procedure", in other words, hammertoe done on RT 2nd and tenotomy on RT 3rd you could add the modifier. Since it is on the same toe, only 28285 can be billed. Sometimes the work required is more than average repair, other times it might be easier. If you feel the work is significantly above the norm, then consider appending CPT 28285 with a 22 modifier.