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DX RT foot hallux valgus w/hallux rigidus with 2nd, 3rd, 4th & 5th hammer toes

Yvette Posted Mon 07th of October, 2019 15:48:45 PM
Operation: 1. RT foot first MTP fusion 2. RT foot angular correction of 2nd MTP joint with removal of hardware. 3. RT foot 3rd hammertoe correction with proximal IP joint fusion & dorsal capsulotomy of the 3rd MTP joint 4. 4TH hammertoe correction with proximal IP joint fusion. 5. Percutaneous pinning of 5th hammertoe 6. Extensor digitorum longus tendon lengthening of the 2nd toe. Need help with CPT codes.
SuperCoder Answered Wed 09th of October, 2019 08:03:03 AM

Hi Yvette,

Please find below the codes for the mentioned procedure:

1. RT foot first MTP fusion

CPT 28750 (Arthrodesis, great toe; metatarsophalangeal joint) can be used with modifier T5.

 

2. RT foot angular correction of 2nd MTP joint with removal of hardware.

CPT 28308 (Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each) can be used with modifier T6.

 

3. RT foot 3rd hammertoe correction with proximal IP joint fusion & dorsal capsulotomy of the 3rd MTP joint.

CPT 28285 (Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) can be used with modifier T7. Capsulotomy might not be paid separately. You can append modifier 22 (Increased Procedural Services) can be append in case there is excessive word performed.

 

4. 4TH hammertoe correction with proximal IP joint fusion.

CPT 28285 (Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) can be used with modifier T8. If billing all the codes together, then append modifier 59 also with CPT 28285, because Code 28285 is a column 2 code for 28750 as per CCI edits guidelines.

 

5. Percutaneous pinning of 5th hammertoe.

CPT 28286 (Correction, cock-up fifth toe, with plastic skin closure (eg, Ruiz-Mora type procedure) is most appropriate code to bill for cock-up/hammertoe deformity correction for fifth toe, but not only for percutaneous pinning. There is no specific code available for percutaneous pinning of fifth hammertoe, it is suggested to use CPT 28899 (Unlisted procedure of toes) with modifier T9.

When reporting a procedure with an unlisted code, submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis, and they will determine payment based on the documentation you provide.

 

6. Extensor digitorum longus tendon lengthening of the 2nd toe.

CPT 28234 (Tenotomy, open, extensor, foot or toe, each tendon) can be used with modifier T6.

If billing all the codes together, then append modifier 59 also with CPT 28234, because Code 28234 is a column 2 code for 28750, 28285 and 28286 as per CCI edits guidelines.

Hope this helps!

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