Billing/Coding 28470

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Hello,

Can someone help clarify how to code this note.

The doctors assessment says closed nondisplaced fracture of metatarsal bone left foot., unspecified metatarsal, initial encounter- We coded S92.302A

Procedure codes billed were 28470 billed separately/each- with modifiers. So 28470 was billed x 5. We got a denial stating too many units.
We are trying to bill Medicare, NGS....can anyone help?
 

shecodes

Networker
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The NCCI manual states the following:

14. If a single cast, strapping, or splint treats multiple closed fractures without manipulation, only one closed fracture treatment without manipulation CPT code may be reported.

...

These policies also apply to the closed treatment of multiple fractures not requiring application of a cast, strapping, or splint. Thus if multiple closed fractures occur in an area that would have been treated with a single cast, strapping, or splint, only one CPT code for closed fracture treatment without manipulation may be reported.
 
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Thank you for the information. So reporting 28470 only once is appropriate but do we apply the 5 units or only use 1 unit?
 

CodingKing

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There is a MUE assigned of 2 so I'm thinking they want a max of 1 unit per foot. Looking at the CPT manual reference "multiple closed fractures occur in an area that would have been treated with a single cast, strapping, or splint" Your 5 metatarsals fractures would be treated by a single cast, strapping or Splint meaning 1 unit.

Although I'm curious on the DX selection. There are 5 metatarsals in the foot so if all of them are broken, how is the DX Unspecified?

It should be:

S92.315A
S92.325A
S92.335A
S92.345A
S92.355A
 
Last edited:

nlbarnes

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28740

I hope someone can possible answer this for me. I'm new to this practice and the trauma doc is billing for 28470 stating "patient was treated with analgesics and physical therapy".

I've never seen this before. And it was an open fracture.
 

mitchellde

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You are going to need to read the note because something is amiss. You cannot have an open fracture treated with closed treatment.
 
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