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28010 multiple toes (Medicare patient)

  1. #21
    Medical Coding Books
    28011 should be billed for this procedure with the t modifiers
    the code is for each toe with multiple tendons

    Medicare will only pay 5 lines with the 6th - 10th by appeal and op note.

    You wouldn't want to bill it with a 50 because its each toe and not feet

    Hope this helps

  2. #22
    Columbia, MO
    I looked at the code a second time here and you are correct it is for multiple tendons on each toe. Subtle but true! I am not sure why you are having issues with Medicare past the 5th line. I have never had an issue with billing 10 toes or 10 fingers for my hand surgeons, you do need to submit a multi page claim, you put the page numbers on (software should do this) and you total the charges on the last page only. I do this several times a week in three different states and never had any issue with Medicare or any other payer.

    Debra A. Mitchell, MSPH, CPC-H

  3. #23
    Thumbs up
    Thanks a bunch

  4. Default
    Back in 2008 there was an AMA response that stated the CDR was incorrect in their publication for CPT 28011. As indicated by the CPT code descripter 28011 is for multiple tendons not multiple "toes". For instance one tendon release in one toe would be reported 28010 with the toe modifier. If you have ONE tendon in two different toes(2nd and 3rd digit right) this would report as 28010-T6 and 28010-T7. (one tendon in each toe) .

    Somtimes they may release 2 seperate tendons in the 3rd toe right, 28011-T7(MULTIPLE TENDONS IN ONE "TOE")

    The CPT descipter for 28010 is "toe", singular not "toes"

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