Forum - Questions & Answers

Sep 28th, 2009 - cberkovatz

modifier 59 vs 51

Hello the Dr I work for did a 28022 ($960.00) dx 838.05 and 28285 ($800.00) dx 735.4. The doctor said we should have billed liked this 28022-59 and 28285-51. I billed it as 28022 and 28022-59. What do you all think. Thank you Cindy B

Sep 28th, 2009 - nmaguire   2,606 

CCI Edit

Code 28022 is considered a part of code 28285. There is a modifier of "1". This means that code 28022 is only billed if unrelated to code 28285. If documentation supports medical necessity of 28022 (unrelated to main code), modifier 59 may be added to code 28022 to bypass the edit. No guarantee of payment. The modifier 51 is not appropriate. But, final decision must be based on documentation and medical necessity.
Hammertoe corrections are reported with CPT code 28285. The AAOS Complete Guide to Global Service Data, states the following procedures would be considered/included in the reporting of 28285:

Arthrotomy (eg 28022)
Extensor tenotomy and repair (eg 28208, 28234)
Capsulotomy for joint contracture (eg 28272)
Synovial biopsy (eg 28054)
Internal fixation (eg 28675)
Implant insertion
Excision of exostosis (eg 28124)
Excision of skin lesion (eg 11420-11426)
Hemiphalangectomy (eg 28126, 28160)
Local bone graft
Phalangectomy (eg 28150)



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