09/07/2018

Correct Billing for 3 Fractures-Right Foot-Medicare

coding question for Medicare Patient, we are treating a patient for 3 fractures . (Fx met 3,4,5 Right foot) We are wondering what the correct way to bill the fracture management is. Thank you so much

There are three different codes that can be billed, depending on the type of fracture the patient has- each code would be billed for one unit of service with the appropriate T modifier (-T7, -T8 or -T9), below are the three CPT codes that could be billed:

Code Description:

28470 (Closed treatment of metatarsal fracture; without manipulation, each)

Lay Description:

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 the Musculoskeletal System. Durable Medical Equipment (DME) dispensed at the time of this service may be reported with the appropriate HCPCS "E" and "L" codes. Check with the specific payer to determine coverage. 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.

Code Description:

28475 (Closed treatment of metatarsal fracture; with manipulation, each)

Lay Description:

The physician treats a fracture of one of the five metatarsal bones in the foot without performing open surgery but with manipulation of the fracture. X-rays (separately reported) confirm a fracture of the metatarsal bone with the bony pieces in an unacceptable position. The physician pushes, pulls, or other maneuvers the foot to restore the fracture fragments to a satisfactory position and alignment. X-rays (separately reportable) confirm desired results. The foot and leg are placed in a cast or brace.

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 the Musculoskeletal System. Durable Medical Equipment (DME) dispensed at the time of this service may be reported with the appropriate HCPCS "E" and "L" codes. Check with the specific payer to determine coverage. 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.

Code Description:

28485 (Open treatment of metatarsal fracture, includes internal fixation, when performed, each)

Lay Description:

The physician treats a fracture of one of the five metatarsals with open surgery. An incision is made overlying the particular metatarsal fracture. The tissues are dissected and debrided as needed. The fracture is identified and exposed. Any tissue between the fracture pieces is removed. The fracture fragments are reduced (realigned) to their correct position. Fixation devices are applied as needed to hold the fracture in place. The wound is irrigated and closed in layers.

Coding Tips:

Internal fixation, when performed, is included in this procedure. External fixation, if performed, may be reported separately. 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 the Musculoskeletal System. For closed treatment of a metatarsal fracture, see 28470-28475. For percutaneous skeletal fixation of a metatarsal fracture, see 28476. For radiology services, see 73620-73630.