Wiki Denial for 28308 with diagnosis code M20.42

[klpage69]

I am in need of help with a diagnosis code for 28308. MCA Administrators is denying 28308 for the use of diagnosis code M20.42, they stated "There is a more appropriate diagnosis code for the procedure billed". We have appealed this 2x because Supercoder shows M20.42 is a billable diagnosis code. The diagnosis the dr. had listed was Hammertoe with capsulitis second MTP joint left foot. Any help would be greatly appreciated!!

 

[Orthocoderpgu]

Are you billing any other code for the hammertoe other than 28308? If the patient has hammertoe which is being treated with bone cutting, 28285 would be more appropriate I would think. Hammertoe is an abnormal bending at the PIP. This is simply an osteotomy of the metatarsal, which I don't see for helping the hammertoe by itself.

 

[klpage69]

Yes.... he first billed out this:
28285 - T1 - M20.42 - PAID
28308 - LT - M20.42. M77.52 - DENIED
I was denied for "Procedure not compatible with diagnosis". He then changed it to M65.872 and it was denied stating "There is a more appropriate diagnosis code for the procedure billed" The diagnosis he had on his OP note was "Hammertoe with capsulitis second MTP joint left foot" and Procedure was 1. Hammertoe operation (PIP joint arthrodesis) left second toe. 2. Capsulitis second MTP joint left foot.

 

[Orthocoderpgu]

So your problem was linking the hammertoe diagnosis M20.42 with the osteotomy. My foot doc will perform a distal osteotomy for metatarsalgia frequently. I just did some Googling and found out that abnormal bone growths can cause capsulitis and that osteotomy can be a treatment for that. Remove the M20.42 and bill with the enthesopathy code. I would not be surprised if you have to appeal this though.