If our provider does multiple Tenotomy procedures on one visit on different toes what are the appropriate procedure codes and modifiers to bill correctly? We have been billing 28010 with the "T" modifier and no other modifiers per the provider's request. I feel like we should be adding a "51" modifier on all lines except the first. I would love assistance with this.
It appears that percutaneous tenotomies are being performed. There are two possible CPT codes for this procedure set.
1. CPT code 28010 which is defined as: Tenotomy, percutaneous, toe single tendon
2. CPT code 28011 which is defined as: Tenotomy, percutaneous, toe; multiple tendons
If a percutaneous tenotomy is performed on 1 tendon on 1 toe, the correct CPT code to bill would be 28010. This would consist of the procedure being performed on either the extensor tendon or the flexor tendon.
If percutaneous tenotomies are performed on more than 1 tendon on the same toe, the correct CPT code would be 28011. This would be the code to bill if percutaneous tenotomies were performed on both the extensor tendon AND the flexor tendon.
It appears that the issue at hand is the appropriate fashion to bill for one percutaneous tendon on more than one toe on the same date of service. I checked the MUEs or the Medically Appropriate Edits in order to see how many times that CPT code 28010 can be billed on the same date of service. The answer is 4. So, in reality, a percutaneous tenotomy can be performed on 4 different toes on the same date of service, justifying the billing of CPT code 28010 four times.
How can these multiple percutaneous tenotomies be billed? It would be most appropriate to bill each of the percutaneous tenotomies on a separate line appended by the correct toe modifier. The 51 modifier is moot. It is almost never needed. It would be quite clear and evident that by appending each of the procedures with the correct toe modifier, this should achieve payment.
For example, if percutaneous tenotomies were performed on the extensor digitorum longus tendon on toes 2-5 on the right foot, the correct coding scenario would be the following:
28010 - T6
28010 - T7
28010 - T8
28010 - T9
This is my opinion.
Michael G. Warshaw, DPM, CPC
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