12/09/2019

Correct Coding for MCR Patient with S/P Non-Displaced Fractures Metatarsal (3,4-RT) with Displacement of 2nd Metatarsal Fracture RT with Attempted Unsuccessful Reduction Under Local Anesthesia

How would you code a Medicare Patient who presents 3days s/p non-displaced fractures metatarsals 3,4 Right & with displacement of 2nd metatarsal fracture right with attempted unsuccessful reduction under local anesthesia. Each time an x-ray is taken to assess healing do I need a modifier?

The procedure for each toe would be coded with CPT 28470. Each line item will require two modifiers-79 since the patient is within the post op period of the prior procedure, and the toe modifier secondary (-T6, -T7, and -T8).

X-rays are allowed to be billed during the post op period for separate reimbursement even if it’s only to assess healing and progress from the surgical procedure.

28470

Closed treatment of metatarsal fracture; without manipulation, each

Lay Description (Code):

The physician treats a fracture of one of the five metatarsal bones without open surgery or any manipulation of the fracture. X-rays (separately reported) confirm a fracture of a metatarsal bone of the foot with the fracture fragments in acceptable position and alignment. The physician places the foot, ankle, and leg in a cast, splint, or brace as needed.

Coding Tips

According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure. See "Application of Casts and Strapping" in the CPT book in the Surgery section, under Musculoskeletal System. For percutaneous skeletal fixation of a metatarsal fracture, see 28476. For open treatment of a metatarsal fracture, see 28485. For radiology services, see 73620–73630.