Chari Posted Mon 16th of July, 2018 20:50:17 PM
procedure performed was repair 1st metatarsal stress fracture, tibal sesamoid stress fracture, and repair ostrochondral lesion 1st metatarsal head using Intraosseous Bio Plasty.. would this be coded 28899.. or is there a specific code for this procedure.
SuperCoder Answered Tue 17th of July, 2018 04:53:41 AM
In foot and toes section divided into subsections of Incision, Excision, Introduction or Removal, Repair, Revision and/or Reconstruction, Fracture and/or Dislocation, Arthrodesis, Amputation.
In this section, sesamoid fracture treatment leads to CPT 28530; in this procedure the provider adjusts the fractured fragment by exerting pushing or pulling force on the foot to reduce the fracture then places the foot in a splint or brace for specific period, but as per provided document, it seems to be inappropriate code for this procedure. On the other hand, there is no such specific code to represent the mentioned procedure. Hence, CPT 28899 is appropriate code to bill for the procedure.
Make sure 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.