02/24/2020

Correct Coding for Non Displaced Fractures of Metatarsals 2, 3, 4-RT and X-Rays (3 Views)

An initial office visit PT was diagnosed with non-displaced fractures of metatarsals 2,3 &4 RT foot. radiographs(3views) were taken. The diagnosis codes were: S92.324A, S92.334A & S92.344A. The CPT codes were: 99203-25, 73630 RT, 28470 T6, 28470 -59-T7, 28470-59 -T8. The (3) 28470 codes were denied.

The fracture procedures could have been denied by Medicare for the number of units billed due to the current CCI/MUE documentation, billing more than two units per day is deemed excessive under normal circumstances. In order to receive payment for all three services, redetermination needs to be submitted to Medicare to appeal the denial.

All supporting documentation from the visit must be included to justify the medical necessity of what was billed and to show that the surgical procedures should be paid in light of any office notes, radiology records, and other documentation on file.

In addition, when billing, if your using a T- Modifier there is no need for the use of Modifier-59 as this is also deemed a misuse of Modifier 59.