Wiki mallet finger, second request

[NEOSM507]

Hi, sorry for the repeat question, but my initial request for help on this in June yielded no responses!

I am getting frequent denials for closed treatment of mallet finger (26432) when performed in an office setting. I am unable to find a source that states it must be performed in a hospital setting. Aetna cited CMS guidelines, but I am still unable to come up with any policy on it. If anyone can help, I'd appreciate it.

Thank you!

 

[such78]

Hi, sorry for the repeat question, but my initial request for help on this in June yielded no responses!

I am getting frequent denials for closed treatment of mallet finger (26432) when performed in an office setting. I am unable to find a source that states it must be performed in a hospital setting. Aetna cited CMS guidelines, but I am still unable to come up with any policy on it. If anyone can help, I'd appreciate it.

Thank you!

Did you apply a modifier to indicate the specified finger?

 

[dkissel]

I believe you can check the MFSDB and under the column marked NON FAC NA INDICATOR it will tell you if the procedure can be billed in office. I have been using this and so far it has been correct. If there is an NA in the column, you can only bill in a facility.