I need some help wrapping my head around some of these fusion codes. The physician did a medial cuneiform to navicular fusion, then a intercuneiform fusion (medial and intermediate), then a 2nd TMT fusion, then a 3rd TMT fusion. I can see how this should be 28730 for the 2 midtarsal fusions. I do not see why the 2 TMT fusions would not be separate. They are not all fused together. They were done through a separate incision. Since the 28730 is for midtarsal OR tarsometatarsal can I bill it twice at least? I also do not understand why the 28740 for a single joint has a higher RVU then the 28730. Why would MORE work pay less? My brain wants to code this as 28730 and 28740 x2, but I know that isn't correct. 28730 for multiple joints to me would mean multiple joints fused together. The TMT joints are not fused to the cuneiform so that to me would be separate. The TMT joint fusions are a single joint fusion. Seems like you get ripped off for doing more work no? Can anyone help me understand? Thank you!
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Wiki Foot fusion question
- Thread starter nmendez1
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Orthocoderpgu
True Blue
Your by far not the first nor the last to discover this conundrum. And to take this a step further both codes have an MUE policy edit of one. Meaning that only one will be paid per day. Welcome to the club.
And I am assuming that trying to bill 28730 for the midtarsal and 28740 for the TMT would be totally wrong since it is the same foot as well correct?
Orthocoderpgu
True Blue
That is the basic consensus of foot & ankle coders that I have been in contact with.
amyjph
True Blue
Yup, stinks. it's the words "multiple or transverse" and that it includes one or more of the midtarsal or TMT. 
The work RVU is a little higher for 28730, but yes the total RVU is less.
The work RVU is a little higher for 28730, but yes the total RVU is less.
Orthocoderpgu
True Blue
Those ARE the magic words!Yup, stinks. it's the words "multiple or transverse" and that it includes one or more of the midtarsal or TMT.
The work RVU is a little higher for 28730, but yes the total RVU is less.
Lblumsden4
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I am glad I found this thread. I was actually thinking it was a mistake that 28740 pays more than 28730! It just doesn't make sense that a multiple or transverse arthrodesis would pay less than a single arthrodesis. I read that PE accounts for 45% of the total payment, but then the description of how it is computed seemed to ramble on with no clear answer only stating "data collected". Guessing it is an accept and move on situation unfortunately. Of course the practice I code for does more multiple!