08/02/2022

Correct Billing for Lapidus Bunion Procedure with Hammertoe Correction to RT-Digits 2 and 4

My Billers are having difficulty getting paid for a Lapidus bunion procedure with hammer toe correction to digits 2 and 4 all the to right foot. Modifier issue. Should we be billing it: 28297 28285 XS, RT 28285, XS, RT or 28297 28285, XS, T6 28285 XS, T8 Thank you

After review of the EOB from Blue Cross, there are two issues that caused all three-line items to deny for an invalid modifier. First, CPT code 28297 should not be reported with a -RT modifier. While this modifier is technically appropriate, the modifier should be more specific with the T modifier that correlates to this surgical procedure, -T5. In addition, since CPT 28297 should have a T modifier, the use of modifier -59 on the hammertoe corrections is inappropriate. Since each procedure was done on a separate digit with its respective T modifier, the use of modifier -59 is not necessary to justify separate payment. With these modifier corrections, a corrected claim should adjust the denial from Blue Cross.