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Metatarsal #5 resection

  1. #21
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    Medical Coding Books
    I understand CCI edits require the 59, but I do not see anything that justifies the use of it. There is nothing separate and distinct to me to justify the use of the 59 modifier. The metatarsal head was resected as incident to the amputation, thats why the CCI edits bundled it.

    Mary, CPC, COSC

  2. #22
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    ok so this has been really bugging me all day so I had to do some further research.

    Per the AAOS 2009 Complete Global Service Data

    The CPT code 28220 includes the following procedures as part of the global surgical package:
    28232
    28234
    28270
    28288
    and 28122

    This confirms my thought process that the 59 modifier would not be justified unless it was on a different metatarsal.

    Mary, CPC, COSC

  3. Default
    Quote Originally Posted by mbort View Post
    ok so this has been really bugging me all day so I had to do some further research.

    Per the AAOS 2009 Complete Global Service Data

    The CPT code 28220 includes the following procedures as part of the global surgical package:
    28232
    28234
    28270
    28288
    and 28122

    This confirms my thought process that the 59 modifier would not be justified unless it was on a different metatarsal.

    Mary, CPC, COSC
    It's 28820 and 28122 not 28220.
    According to the coders desk reference 28820 is an amputation of a toe at the level of the metatarsopalangeal joint, the proximal phalanx is disarticulated from the metatarsal bone. They don't go into the metatarsal at all in this code. So then you would code 28122 for the partial excision of a metatarsal bone.

  4. #24
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    sorry for the typo, that is the AAOS global service package for 28820.

    We will have to agree to disagree on this one. I understand the CDR, however I also utilize the AAOS as a premium guide when coding Ortho cases.

    In my opinion, there is nothing distinct to stand alone to justify the use of the -59 modifier.

    Mary, CPC, COSC

  5. Default
    Ok, I think the AAOS is a good reference to go by, and they are probably saying it is inclusive because you go so close to the metatarsal bone that they are just including that. So I see your point as to why you go by them, but I'm going by what the CDR says and also I have Netters Atlas of Human Anatomy for CPT coding and I use that to look at the bones of the foot. So I guess we will agree to disagree on this one.

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