Coding help needed for denied modified Weil

aceubanks

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My physician performed a Fusion 1st MT right, Modified Weil Osteotomy 2nd MT right and Arthroplasty 2nd right. Diagnoses were Hallux Valgus, Plantar Flexed MT, and Hammertoe.

I coded this surgery as
28750 (T5) / M20.11
28308 (T6, 59) / M20.5x1
28285 (T6, 59) / M20.41

I have a claim administrator that is denying the 28308 stating the that the diagnosis and procedure are not compatible (although I have not encountered this problem with any other insurance).

I could possibly re-code the diagnosis as a Long Plantar Flexed MT as that is documented in our notes, but am not sure if that would solve the problem. (am thinking that code would be M21.6x1???)

Any thoughts on the coding and how to get the Weil reimbursed?
 
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Metatarsal is a long bone in the foot

Hello aceubanks,

I'm thinking insurance denied the DX because it is specific to the toe where the metatarsal is a long bone in the foot. In coding the DX for plantarflexed metatarsal you need to determine if the deformity was acquired or congenital or is the deformity bone-related, joint-related or soft tissue-related. I'm sure since you have the notes that this is acquired (hence your new DX choice), so your DX of acquired deformity of the right foot is correct.

:)

M.Hannus, CPC, CPMA, CRC
 

aceubanks

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Hello aceubanks,

I'm thinking insurance denied the DX because it is specific to the toe where the metatarsal is a long bone in the foot. In coding the DX for plantarflexed metatarsal you need to determine if the deformity was acquired or congenital or is the deformity bone-related, joint-related or soft tissue-related. I'm sure since you have the notes that this is acquired (hence your new DX choice), so your DX of acquired deformity of the right foot is correct.

:)

M.Hannus, CPC, CPMA, CRC
Thank you meganhannus!
 
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