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Can someone review chart note to see if I'm on the right track?

ollielooya

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Hello again, colleagues,
After receiving helpful advice from a fellow member, have come across another scenario that is baffling due to my limited experience in this type of coding.

PRE-OP DX: ischemic ULCER RIGHT LATERAL FOOT
post-op dx: osteomyelitis WITH ISCHEMIC ULCERATION OF RIGHT LATERAL FOOT INVOLVING 4TH AND 5TH METATARSAL AND CUBOID BON

Performed:
1) debridement of right foot to include skin & soft tissue and cuboid bone right foot.
2)Right 5th metatarsal resection, partial
3) right 4th metatarsal resection, partial

Description: (extraction of pertinent verbiage). Ischemic ulceration was then debrided over the lateral foot. This clearly involve the 5th metartarsal bone.
Wound did extend more medially w/involvement of the cuboid bone as well as the 4th metatarsal. These were all sharply debrided back with a rongeur and
the 5th metatarsal was resected along with a portion of the 4th metatarsal. Would was packed w/saline-good bleeding was appreciated from wound bed.

My efforts: I see a debridement here in #1, but not sure about the two codes for #2 and #3. I'm thinking 28122, 28122. (The 5th metatarsal was resected, with a portion
of 4th?), so not sure about choosing the same code for both procedures when one was a partial.

Can anyone offer guidance?
 
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Hello ollielooya,

I know I have chimed in with some coding help on one of your coding scenarios in the past....

I would query the provider to double check and see if they decided to completely resect the 5th metatarsal bone due to osteomyelitis in order to properly code.

If only a partial resection was performed due the osteomyelitic bone I agree with you in only coding CPT 28122 for the 5th metatarsal bone and CPT 28122 Modifier XS (or 59) for the 4th metatarsal bone. You can code CPT 28122 twice with a modifier since there is more than one metatarsal bone in the foot. The cuboid bone is one of the seven tarsal bones in the foot but it seems as if it would be inclusive to CPT 28122-XS billed for the 4th metatarsal. I also do not think a bone debridement code (CPT 11044) is fitting because I believe the purpose of the procedure was to remove the osteomyelitis (infection within a bone) where as debridement to the bone is to remove/excise the affected tissues into the bone.
 

Orthocoderpgu

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28122, 28122-xs, 11044-XS

While there is clearly debridement of bone of the 5th metatarsal and 4th metatarsal (11044) but resection of the bone (28122) which is more involved was also performed on the same bones. So 11044 bundles with 28122 in this case.

However, you can bill 11044 for the cuboid which did not have resection performed.

Code 28122 has an MUE of 4 so you can bill this code twice.
 

ollielooya

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Thanks for assistance with this scenario

Yes, Meghan you have helped me before on another note, and I've taken note of your other postings in the past. Nice to see familiar names, as I've only returned to the forums recently.

Orthocodergu, Thank you so much for your assistance and clear modifier usage. Both your posts helped to validate some of my initial thoughts even though I am
unexperienced with this type of coding. I value both your comments.
 
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