Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

billing 28820 and 28122 together

Jeannie Posted Sat 02nd of May, 2020 14:42:14 PM
A podiatrist wants to bill 28820 and 28122 together for an amputation at the MPJ and a partial resection of the corresponding metatarsal. The toe was dis-articulated at the MPJ, and then the metatarsal was resected at the mid-shaft. Both procedures were through the same incision. Since 28122 bundles to 28820, it would seem that they couldn't be billed together for the same toe/metatarsal. Aside from separate toe or separate incision, is there any other circumstance that could justify modifier -59? According to my AMA coding companion, it seems that the more appropriate code may be 28810 since a significant portion was resected. If so, would a modifier -52 be needed since the whole metatarsal wasn't removed? I'd really appreciate some input on how to bill this type of procedure correctly. Thanks so much!
SuperCoder Answered Mon 04th of May, 2020 10:54:02 AM

Hello Jeannie,

Thank you for your question.

 

As per the above provided documentation, the amputation was performed at the metatarsophalangeal joint, for which CPT® code 28820 is appropriate. In this procedure, the provider amputates the toe at the metatarsophalangeal joint. The metatarsophalangeal joint is the joint between the first metatarsal of the foot and the first phalanx of the toe.

 

Per NCCI Edits, there is a bundling conflict between CPT® codes 28122 and 28820. CPT® code 28122 is getting bundled with 28820. Since, the site of incision, same toe and same encounter, the bundling cannot be ruled out. If the toe would have been different, or separate incision would have been made to access the site, it would be appropriate to report both procedure(s) with modifier 59.

 

Now, in CPT® code 28810, the provider makes an incision in the skin over the metatarsal to be removed at the tarsometatarsal joint. Tarsometatarsal joints are also known as Lisfranc joints. They are the joints where the first, second, and third cuneiforms, and the cuboid meet with the bases of the metatarsal bones. The provider dissects down through subcutaneous tissue to access the tarsometatarsal joint. He next incises the capsule and separates the metatarsal at this joint. He ligates the blood vessels and retracts the nerves. He then transects and divides the muscles’ tendons. He finally resects or cuts the metatarsal bone along with its toe by extending the incision. Finally, after irrigation of the wound with antibiotics, he closes the wound by suturing the flaps and packs the wound with antiseptic gauze.

 

Also, it is advised to correlate the CPT® code 28820, with your detailed procedure note, before final billing.

 

Hope that helps!

Thanks

Jeannie Posted Mon 04th of May, 2020 20:50:29 PM
Thanks so much for your detailed answer. So to make certain that I understand correctly... Since 28122 bundles to 28820, modifier -59 could only be used: 1) different toe, 2) separate surgical incision, or 3) separate encounter. And do I understand correctly that 28810 would only be used if the amputation occurred at the TMJ? MPJ amputations with partial resection of metatarsal is just 28820 (unless separate toe, separate incision, or separate encounter) no matter how much of the metatarsal is removed? One last thing...at what point does it become a partial ray amputation and would the right code for that be 28810. I find these codes a little intimidating! Thanks for your help :)
SuperCoder Answered Tue 05th of May, 2020 07:52:38 AM

Hello Jeannie,

Thank you for your question.

 

If your detailed documentation supports that ray amputation was performed, then appropriate code will be 28810, as this code will cover up the portion of metatarsal (significant portion resection) and MPJ joint amputation. In code 28810, the provider amputates a single metatarsal bone along with its attached toe.

 

For ray amputation, either partial or complete, the appropriate code will be 28810.

 

So, look at your detailed procedure note carefully for the actual work performed.

 

Hope that helps!

Thanks

Related Topics