Podiatry Coding & Billing Alert

Question: A podiatrist in our office just did a hammertoe correction using an interphalangeal fusion. For that, I report 28285. But once the patient's foot has healed, I'm wondering how to code for the removal of the K-wire. Is there a modifier I should use in addition to the code? California Subscriber Answer: You may not bill separately for the removal of a Kwire when you are reporting 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) because the K-wire removal is bundled into the procedure. If the foot has healed properly with the pin still outside the skin, you can't bill for it. Using 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) would also be inappropriate.

Don't miss: There is one case in which you can recoup reimbursement for the wire removal: if the K-wire has been cut and got buried beneath the skin. In this case, use 20670 (Removal of implant; superficial [e.g., buried wire, pin or rod] [separate procedure]) or 20680 (Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]). But keep in mind that some carriers are picky about reimbursing 20680.

Next, determine the setting of the procedure. If the podiatrist took the patient back to the operating room to remove the wire, append modifier 78 (Unplanned return to the operating/procedure room for a related procedure during the postoperative period). But if the podiatrist simply numbed the toe and removed the K-wire in the office (which happens most of the time), leave the code as is or use modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) if the procedure is under the global. Careful: Not all carriers accept modifier 58 and will deny on the basis that the wire removal is still bundled into 28285. However, if the procedure is outside the global, you shouldn't have a problem reporting the wire removal.