There can be times when you have to report flexor tenotomy with hammertoe correction. But National Correct Coding Initiative (NCCI) doesn’t bundle the two services together so how do you report the two together. Read on to learn how and when can you report 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) for hammertoe correction and 28232 (Tenotomy, open, tendon flexor; toe, single tendon [separate procedure]) for the flexor tenotomy on the same toe when your surgeon performs these procedures.
“Medicare does not always incorporate the CPT® ”separate procedure” codes into the NCCI edits, but rather assumes that the coder will recognize coding scenarios in which a procedure or procedures are an integral part of the progression to the end procedure and, therefore, may not be billed separately,” says Josie Dunn, CPC, Department of Orthopaedics, University of Maryland Faculty Practices, Maryland.
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Learn What 28285 Includes
The code 28285 is inclusive of extensor tenotomy. “The open flexor tenotomy (28232) is designated as a separate procedure by CPT® ; however, only an extensor tenotomy is considered to be bundled into 28285 according to AAOS Global Service Data,” says Ruby O’Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist, Twin Cities Orthopedics, P.A.
Payor challenges: You may face payor push-back for flexor tenotomy claims as some payors may just refuse to accept the flexor tenotomy as separate. “I would not report 28285 and 28232 together on the same toe, as the AOFAS states the work performed doing the tenotomy is included in 28285, either extensor or flexor,”...
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