tci ED Coding & Reimbursement Alert - 2004 Issue 11

Reader Question: Multiple Toes Call for Modifier -51

Question: If a patient has four fractured metatarsals on the same foot, should I report code 28470 one time, or four times? The code specifies "each." Should I append any modifiers?New Mexico SubscriberAnswer: Because code 28470 (Closed treatment of metatarsal fracture; without manipulation, each) does reference "each," you can report it multiple times using modifier -51 (Multiple procedures). Some payers may also require use of the HCPCS level II codes -TA (Left foot, great toe) and -T9 (Right foot, fifth digit) to identify the specific digits involved. Although reporting each procedure using modifier -51 is correct...

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