Wiki T mods and F mods for metatarsal and metacarpal procedures.

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I was recently audited on my use of T mods for metatarsal procedures and F mods for metacarpal procedures and was told they should not be used on these procedures only on toe and finger procedures. I asked them to site the authority to which this decision was made and have yet to hear back from them. My argument is that the otpum software encoder pro shows that the T mods and F mods are appropriate to use on the metatarsal and metacarpal procedures and in my many years of coding I have never once had a denial or ding on any other audit. Please let me know your experience with this issue. thank you
 
In the "coding" rules and "test world" the T & F mods are for phalanges/digits only. If you read the Level II HCPCS National Modifiers section where they are listed in Appendix A of the CPT book, the word digit is why.
Digit means phalanges. The tarsals and carpals are not digits. It is anatomy. Technically, they should not be used on metacarpal/metatarsal.

HOWEVER, in the real coding/billing world these modifiers are often used either way. That's probably why Encoder Pro shows this, but there is always the caveat that it depends on the payer. Some payers will deny for T or F when used with a metatarsal or metacarpal and they want RT/LT. Some payers don't care either way.
I personally would not make a negative finding for a coder under review during the course of an internal coding audit for this issue, it is more educational. If a practice was receiving denials for the anatomic modifiers, then I might go a different route.

Here is an example of MAC info on it. It specifically states digit (except for the thumb)

As an example, I have seen where one payer wants only RT/LT if billing a 28296 but another would accept either RT/LT or the T mod, and yet another only wants the T (which make no sense because these are only done on the great toe or first MT)

You can search for anatomical modifiers policies in payer policies, but a lot of times they may not specifically address this issue with the toes/fingers.
 
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