• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Coding help needed for denied modified Weil

aceubanks

New
Messages
7
Best answers
0
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?
 
Messages
173
Best answers
0
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

New
Messages
7
Best answers
0
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!
 
Top