Orthopedic Coding Alert

Can you code these scenarios with the correct finger/toe modifiers?

Sometimes, a concept is tough to grasp unless you see it unfold in real-world terms. Such is the case with the anatomical modifiers assigned to fingers and toes. Using them isn’t always as easy as 1, 2, 3.

Help’s here: We got some help with realistic clinical coding scenarios from a couple of industry experts that have dealt with anatomical modifiers for years. Here’s a couple of anatomical modifier cases to give you a sense of how to use modifiers F1 (Left hand, second digit) through TA (Left foot, great toe). (Refer to the chart in “Go Deep to Ace Anatomical/ Lab Modifier Questions” to get the descriptors for each of the F1-TA modifiers.)

Cases and coding instruction are courtesy of Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania; and Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

Case 1

A patient has a crush injury of the right hand, with open fractures of the proximal phalanges of the second and third digits. He requires an open reduction of each fracture.

Coding:

For this claim, Falbo recommends reporting 26735 (Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each) with modifier F6 (Right hand, second digit) appended; as well as 26735 with modifier F7 (Right hand, third digit) appended.

The use of the anatomical modifiers in this case “ensures that both CPT^® codes will get paid,” explains Falbo.

Case 2

A patient with a painful hammertoe deformity undergoes correction/arthroplasty on the first, second, third, and fourth right toes; and all five left toes. The service also includes a bilateral ostectomy of the fifth metatarsal heads, and a bilateral ostectomy of the great toes.

Coding: For this claim, report the following on separate lines with the appropriate modifiers:

• 28288 (Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head) with modifier TA (Left foot, great toe) appended.
• 28288 with modifier T5 (Right foot, great toe) appended.
• 28124 (Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe) with modifier 50 (Bilateral Procedure) appended.
• 28285 (Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) with modifiers 50, 59 (Distinct Procedural Service), and T5 (Right foot, great toe) appended.
• 28285 with modifier T6 (Right foot, second digit) appended.
• 28285 with modifier T7 (Right foot, third digit) appended.
• 28285 with modifier T8 (Right foot, fourth digit) appended.
• 28285 with modifier T4 (Left foot, fifth digit) appended.

Another modifier … seriously: Despite the modifier saturation on this claim, “some payers may require modifier 51 [Multiple Procedures] appended to 28285 in addition to the anatomical modifier,” explains Falbo. Check with your payers to see if modifier 51 is necessary before filing 28285 twice on any claim.