Metatarsal

​​​​​​​“I saw a patient on March 20, 2020 with a new, mildly displaced 3rd metatarsal fracture (S92.332A). I have been following him since then and have billed Anthem Blue Cross with ICD10 S92.331D and have gotten reimbursed. The last visit I had with the patient was August 17, 2020 and billed Anthem Blue Cross for S92.332S. The claim was denied as Missing/incomplete/invalid principal diagnosis. Isn’t S92.332S a valid primary diagnosis code?”

“On February 11, a patient has a transmetatarsal amputation. The patient is a non-compliant, diabetic. The site deteriorates weeks after he leaves the hospital. On March 24, he was readmitted for an infected at the amputation site. On March 26, the remaining 5 metatarsals stumps are removed, and the wound is kept open. How would you recommend coding for the 2nd surgery? What is the code for removing the 5 remaining metatarsal stumps?”

“We have had more than one claim where Blue Cross Blue Shield of Oklahoma is paying for CPT 28122 but denying CPT 28306, despite the use of the 59 modifier. Our question is why wouldn’t CPT 28306 be allowed instead of CPT 28122 as it is far more work? We are trying to determine how to appeal this.”