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28010 multiple toes (Medicare patient)

  1. Smile 28010 multiple toes (Medicare patient)
    Medical Coding Books
    Hi all,
    I had a patient 28010x10 (all toes addressed)…Did originally bill 28010 w/ T modifiers and rec'd denial. Checked w/ office and then billed 28010 10 units and no modifier.

    Still rec'd denial “Payment adjusted because the payer deems the information submitted does not support this many/frequency services.”
    Op note reads:
    Attention was directed to the plantar surface of the toes. The toes all had a flexion contracture and the patient had a very flexible foot structure. A percutaneous 1-cm incision was made at the plantar surface of all 10 toes and a flexor tenotomy was performed by incising the FDL and FHL tendons at each of the incisions. This decreased the flexor contracture of the toes. The incisions were then irrigated and surtured w/ a single 4-0 Prolene suture in a horizontal mattress suture technique under each toe.


    Medicare indicated to review LMRP but can't find any info….any insight?

    ASC in Indiana….Thanks!

  2. #2
    Default
    per 2008 procedure desk reference

    28010-28011
    This procedure is performed to correct mallet or hammer toe. The physician makes a small incision at the crease of the toe where the tendon is restricted. The tendon is released from the bone and the toe is straightened. The incision is sutured and dressing applied

    REPORT 28011 IF MORE THAN ONE TOE IS BEING STRAIGHTENED.
    Last edited by ASC CODER; 10-07-2009 at 10:56 AM.

  3. #3
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I agree 28011 is the appropriate code to use for more than one toe.
    Mary, CPC, CANPC, COSC

  4. Default
    Since all 10 toes....Use 28011-Rt and 28011-Lt then?

  5. #5
    Default
    This should be 'per' toe as indicated in the description with multiple tendons being released in that given toe.

    T1 Left foot, second digit
    T2 Left foot, third digit
    T3 Left foot, fourth digit
    T4 Left foot, fifth digit
    T5 Right foot, great toe
    T6 Right foot, second digit
    T7 Right foot, third digit
    T8 Right foot, fourth digit
    T9 Right foot, fifth digit
    TA Left foot, great toe


    per your op note "a flexor tenotomy was performed by incising the FDL and FHL tendons at each of the incisions"
    Last edited by ASC CODER; 10-07-2009 at 02:30 PM.

  6. #6
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Lay Description

    This procedure is performed to correct mallet or hammer toe. The physician makes a small incision at the crease of the toe where the tendon is restricted. The tendon is released from the bone and the toe is straightened. The incision is sutured and dressing applied. Report 28011 if more than one toe is being straightened.
    Mary, CPC, CANPC, COSC

  7. #7
    Location
    Jacksonville Beach, FL
    Posts
    71
    Default
    I agree to use 28011 per each toe, per ASC Expert all the modifiers for each of the toes can be used with this code.
    AWest

  8. #8
    Default multiple toes
    I agree with 20811 for multiple toes. One time only. The description is for "multiple tendons".

    According to 3M and encoder pro, if more than one tendon is accessed and cut, use 20811.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  9. #9
    Default
    In our area of the country, Medicare reimburses $107.73 for 28010 and $760.61 for 28011. Considering the lay description of 28011 and the heft of the reimbursement for 28011, I'd say all of the piggies are covered.

  10. #10
    Default
    I say 28011 x2 for bilateral?

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