Wiki 28122 Modifier Question

[jes031@gmail.com]

I am needing help to figure out the correct modifier to use with code 28122. I have billed it with T5 alone and then RT & T5. Insurance continues to deny the claim for "incorrect use of modifier for procedure per CMS/CPT/PLAN guidelines". I am fairly new to podiatry and just can't figure out what I need to use. Thank you for your help.

 

[podcoder70]

28122 is for partial excision of bone of the tarsal or metatarsal. The T modifiers are for toes. The metatarsal is not a toe. Have you billed it with just RT? What payer are you billing?

 

[jes031@gmail.com]

28122 is for partial excision of bone of the tarsal or metatarsal. The T modifiers are for toes. The metatarsal is not a toe. Have you billed it with just RT? What payer are you billing?

No I haven't tried just the RT. Payer is NTC.

 

[amyjph]

Agree with the advice above. Is that the only code on the claim?

 

[podcoder70]

No I haven't tried just the RT. Payer is NTC.

Bill it with RT. If there are other codes on the claim there may be other modifier requirements and if you are billing a commercial plan, they may deny the claim pending receipt of documentation.