11/19/2018

Correct Coding for Arthoplasty PIPJ T4-RT & Hemiphalangectomy T5-RT and Correct Coding for Evaluation and X-Ray Readinga for a Non-Displaced Fracture-5th Met (Patient went to an urgent care center pr

Question 1: What CPT codes, modifiers and diagnosis codes should be used for arthroplasty PIPJ 4th toe-Right and arthroplasty and hemiphalangectomy 5th toe-Right? Question 2: What CPT code should be used when a patient comes to my office the day after the urgent care center with a non-displaced fracture-5th met. Patient was given cam walker at urgent care. I evaluated and read x-rays?

Question one:

• Procedure Codes
• The correct CPT code for hemiphalangectomy is CPT code 28160 (Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each); this would be coded with a -T9 modifier
• There is no CPT code for arthroplasty of the PIPJ joint (only for the IPJ, which does not apply for the scope of podiatry)- the unlisted surgery CPT code would be billed twice (28899)
• One line with a -T8 modifier
• One line with a -59 modifier primary, followed by a -T9 modifier
• I cannot provide information regarding diagnosis codes that should be used; this should already be determined by the patient’s condition and the reason the procedures are being performed.

Question two: The following should be billed:

• An office visit should be billed since the patient was evaluated for their fracture, the level being dependent on the depth of the evaluation and levels reviewed and documented.  The Xray may not be billed for merely for reviewing, but can be part of the E/M.