“I have great difficulty getting paid for CPT 28308 when a hammer toe repair is performed at the same time. The billing scenario generally will look like this:
CPT 28308 (2nd metatarsal osteotomy) -RT
CPT 28285 (2nd hammertoe repair) -T1 -59
We never get paid for CPT 28308 in this scenario. Does anyone have any suggestions? We link the acquired deformity of bone diagnosis to CPT 28308.”
CPT code 28308 is defined as: Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each
CPT code 28285 is defined as: Correction, hammertoe (e.g. interphalangeal fusion, partial or total phalangectomy)
It appears at face value that if both of these procedures were performed on the same foot, the scenario would be billed as demonstrated in the above post.
CPT 28308 – RT
CPT 28285 – T1, 59
However, when the CCI edits are accessed, CPT code 28285 is not a Column 2 code to CPT code 28308, nor is CPT code 28308 a Column 2 code to CPT code 28285. In other words, these two CPT codes are not bundled within the CCI edits. Therefore, a 59 modifier should not be part of the coding scenario.
It is possible that when the 59 modifier was appended to CPT code 28285 in the above post designating 28285 as a Distinct Procedural Service, placing it above and beyond CPT code 28308, it allowed for the reimbursement of CPT code 28285 and the rejection of CPT code 28308. Just a thought.
I believe that based upon the CCI edits that if a second metatarsal osteotomy and a second hammertoe correction were both performed on the same date of service, the appropriate coding scenario would be the following:
CPT 28308 – RT
CPT 28285 – T1
This is my opinion.
Michael G. Warshaw
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