Question: My payer does not recognize modifiers. What can I use in its place?
You might require modifiers to help differentiate work on different areas of the feet or toes. But then it is not normal to have a carrier prohibit the use of toe modifiers, which run sequentially from TA (Left foot, great toe) and T1 (Left foot, second digit) to T9 (Right foot, fifth digit). To differentiate between toes operated on try using modifier 59. Also, you can go for modifier 59 in combination with the toe modifiers: Say for instance 28899-59-T3.
Question: My patient broke his toe (a closed fracture) three days after I carried out a hammertoe correction on that toe (T7) and another toe on the same foot (T8). How should I report this?
As there's no treatment for a broken toe, you could bill the office visit 9921x-24 (Unrelated E&M service by the same doctor during a post-operative period) and cover the ICD-9 code for a fractured toe, 826.0 (Fracture of one or more phalanges of foot, closed).
Since I do not want to use the unlisted-procedure code, what other procedures are close enough to hammertoe to be billed as a hammertoe?
You should think about reporting hammertoe code 28285 for the correction of claw toe or mallet toe.
Question: So can I bill for removal of a K-wire?
The answer is no. you may not bill the removal of a K-wire separately. It's bundled into the procedure. Reporting 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) wouldn't be proper too. If the pin is outside the skin, you cannot bill for it. But then if it needs to be removed because it has been cut and buried beneath the skin, go for 20680 and add modifier 78 which tells the insurance company it was necessary to do a second procedure on the patient.
Is a tenotomy included in the hammertoe procedure?
Well, yes, the tenotomy is included and it should not be billed for separately. But then if you look closely, at the present National Correct Coding Initiative edits only 28234 is listed as bundled into the procedure, not 28232. The flexor tenotomy procedure may be billed differently if a separate incision is used.
You might require modifiers to help differentiate work on different areas of the feet or toes. But then it is not normal to have a carrier prohibit the use of toe modifiers, which run sequentially from TA (Left foot, great toe) and T1 (Left foot, second digit) to T9 (Right foot, fifth digit). To differentiate between toes operated on try using modifier 59. Also, you can go for modifier 59 in combination with the toe modifiers: Say for instance 28899-59-T3.
Question: My patient broke his toe (a closed fracture) three days after I carried out a hammertoe correction on that toe (T7) and another toe on the same foot (T8). How should I report this?
As there's no treatment for a broken toe, you could bill the office visit 9921x-24 (Unrelated E&M service by the same doctor during a post-operative period) and cover the ICD-9 code for a fractured toe, 826.0 (Fracture of one or more phalanges of foot, closed).
Since I do not want to use the unlisted-procedure code, what other procedures are close enough to hammertoe to be billed as a hammertoe?
You should think about reporting hammertoe code 28285 for the correction of claw toe or mallet toe.
Question: So can I bill for removal of a K-wire?
The answer is no. you may not bill the removal of a K-wire separately. It's bundled into the procedure. Reporting 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) wouldn't be proper too. If the pin is outside the skin, you cannot bill for it. But then if it needs to be removed because it has been cut and buried beneath the skin, go for 20680 and add modifier 78 which tells the insurance company it was necessary to do a second procedure on the patient.
Is a tenotomy included in the hammertoe procedure?
Well, yes, the tenotomy is included and it should not be billed for separately. But then if you look closely, at the present National Correct Coding Initiative edits only 28234 is listed as bundled into the procedure, not 28232. The flexor tenotomy procedure may be billed differently if a separate incision is used.
