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Orthopedic Coding Alert

Coding Case:

Advice Helps You Ace Your Tenotomy With Hammertoe Correction Reporting

Make sure you're using the correct modifier and that you check with your payor. Think twice before you report flexor tenotomy with hammertoe correction. The National Correct Coding Initiative (NCCI) doesn't bundle the two services together, but you'll need to exercise caution before you can claim the two together. See our advice below for how and when can you report 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) for hammertoe correction and 28232 (Tenotomy, open, tendon flexor; toe, single tendon [separate procedure]) for the flexor tenotomy on the same toe when your surgeon performs these procedures. "Medicare does not always incorporate the CPT® "separate procedure" codes into the NCCI edits, but rather assumes that the coder will recognize coding scenarios in which a procedure or procedures are an integral part of the progression to the end procedure and, therefore, may not be billed separately," says Josie Dunn, CPC, [...]

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