Wiki 26341 - Multiple Units

[Ruddan]

I was hoping for some clarification on this particular code. I've always been under the impression that we could only bill this code once per palm, but I've recently received some pushback with providers stating they should be able to bill per digit treated. Optum's encoder does not allow for the use of the "F" modifiers, and it has a max unit of 2. Does anyone have any official guidance on this? Any help would be greatly appreciated. Thank you!

 

[amyjph]

The providers are sort of correct, it is per fascial cord (not digit). However, payers may have a max per day, which is normally two cords treated per day. The CPT description is your answer. Check that. It says single cord. The reason you don't/can't use the F mods is because it's in the palm, not the finger. Even though it is impacting a finger.

Example: https://www.aetna.com/cpb/medical/data/800_899/0800.html

Look up payer Xiaflex policies.

The MUE is two.