Wiki Help with capsulotomy and tendon release coding

[kzcoder]

I am coding a surgical record and wanted to know if my CPT findings and modifiers below are correct. I only put the 51 modifier in for Novitas guidelines.

After an Austin bunionectomy was performed on the Right Foot (28296-T5) a dorsal capsulotomy of the 2nd R metatarsophalangeal joint (28270-59-51-T6) was performed followed by a flexor tendon release-tenotomy- of the distal interphalangeal joint of the same toe (28232-59-51-T6) . Since performed on different joint levels (MTP and IP joints) the capsulotomy (higher RVU) and the tenotomy may be billed together with a 59 modifier. Bone work was not performed; therefore, bunionectomy would not be not applicable. 51 modifier is dependent upon payer; while most Medicare carriers do not accept Modifier 51, recommend using 51 modifier for Novitas.

Thanks

 

[nsteinhauser]

It depends on who the payer is and - if audited - who the audit company is - to see what replies you get. But I would use a -RT modifier on 28296 versus the toe modifier (-T5) - you are doing work on the metatarsal (foot) versus just the phalange (toe). Same with the 28270 - since the MTPJ capsulotomy involves the foot at the metatarsal head - I would use a 28270 with a -59 and -RT versus the -59 and T6. And then the 28232 -59 -T6 for the tenotomy. Hope this helps.

 

[kzcoder]

Thank you!

Yes, very helpful, thank you!