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Primary Care Coding Alert

Reader Question:

Yes, You Can Sometimes Bill 28470 and 29405 Together

Published on Thu Sep 06, 2012

Question: Is it appropriate to bill 28470 with 29405? I don't quite understand what 28470 includes.Vermont Subscriber Answer: The most recent Correct Coding Initiative (CCI) edits classify 29405 (Application of short leg cast [below knee to toes]) as a Column 2 code for 28470 (Closed treatment of metatarsal fracture; without manipulation, each). That means you should not normally report both codes for a single date of service. However, the edits do allow you to append a modifier (usually modifier 59, Distinct procedural service) to 29405 in order to report both services. Ensure that you have documentation supporting two separate services before filing a claim with both codes. Code inclusion: By billing 28470, the physician assumes responsibility for treating the fracture (even if it involves minimal care and risk) and agrees to monitor the fracture's course of healing. Medicare assigns a 90-day follow-up time to 28470, but other payers might differ. [...]
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