02/27/2020

Correct Coding for Excision of 4 Fibromas (LT-1ST, 3RD, 5th Metatarsal Head and LT Midfoot)

One of our doctors performed excision of four fibromas on the left 1st, 3rd, 5th metatarsal head area and one on the left midfoot.. of course Excellus has denied three of them - what is the correct way to code them - we used 28090 four separate lines - is that the right code? and please let me know the right way to send

Coverage by Excellus BC/BS would be dependent on the modifier reported for each fibroma excision. Based on the description, T modifiers should be reported for excisions related to the metatarsal heads (-TA, -T2 & -T4), with the last excision in the midfoot appended with modifiers -59/-LT. According to CMS MUE/CCI edits, more than two procedures reported on the DOS would be considered excessive. Blue Cross denied the three subsequent procedures most likely due to a combination of modifier use and where op-reports are going to be needed to substantiate the level of service provided to the patient.