“I have a patient who suffered a Lisfranc injury that resulted in nondisplaced fractures of the 1st, 2nd and 3rd metatarsal bases. There was no disruption of the alignment of the midfoot. We decided that conservative treatment was the most appropriate option for the patient and this injury. She was casted using fiberglass. I am planning to code this treatment as CPT 28470 Closed treatment of metatarsal fracture; without manipulation, each. I was using the APMA Coding Resource Center and noticed that there is “MUE 2″ for this code. Does this affect how many metatarsal fractures that I can bill for during this treatment?”
So, a patient suffered a Lisfranc injury that resulted in nondisplaced fractures of the 1st, 2nd, and 3rd metatarsal bases. The injury was treated conservatively by applying a fiberglass glass to the patient’s affected lower extremity. The question is, if the treatment of the three metatarsal fractures is going to be closed treatment without manipulation using CPT 28470, how many times can CPT 28470 be billed?
First of all, CPT 28470 is defined as the following: Closed treatment of metatarsal fracture; without manipulation each. When the Medically Unlikely Edits (MUE) are accessed, the number is 2 which indicates that this CPT code can be billed twice on a given date of service. However, there is a ruling that supersedes or overrules the Medically Unlikely Edits.
The overruling policy is found within the following publication:
CHAPTER IV SURGERY: MUSCULOSKELETAL SYSTEM
CPT CODES 20000-29999 FOR MEDICARE
NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL
G. Fractures, Dislocations, and Casting/Splinting/Strapping
15. When a fracture or dislocation is repaired, only one fracture/dislocation repair code may be reported. Closed repair codes, percutaneous repair codes, and open repair codes for the same anatomic site are mutually exclusive of one another, and only one of these codes may be reported for the repair of a fracture or dislocation at an anatomic site.
16. If a single cast, strapping, or splint treats multiple closed fractures without manipulation, only one closed fracture treatment without manipulation CPT code may be reported. Additionally, if a single cast, strapping, or splint treats multiple fractures without manipulation in addition to one or more fracture(s) with manipulation, a closed fracture without manipulation CPT code shall not be reported separately. These policies also apply to the closed treatment of multiple fractures not requiring application of a cast, strapping, or splint. Thus, if multiple closed fractures occur in an area that would have been treated with a single cast, strapping, or splint, only one CPT code for closed fracture treatment without manipulation may be reported.
If a cast, strapping, or splint applied after an open or percutaneous treatment of a fracture also treats a closed fracture without manipulation, a closed fracture without manipulation CPT code shall not be reported separately.
These principles also apply to the treatment of multiple dislocations or combinations of multiple closed fractures and dislocations. If multiple dislocations and/or fractures are treated without manipulation and stabilized with a single cast, strapping, or splint, only one CPT code for closed dislocation or fracture treatment (without manipulation) may be reported. Additionally, if a single cast, strapping, or splint treats any combination of closed dislocations and/or closed fractures without manipulation in addition to at least one closed dislocation or fracture that did require manipulation, only a single CPT code for closed treatment with manipulation of the dislocation or fracture may be reported.
Similarly, if multiple dislocations and/or fractures are treated with or without manipulation and do not require a cast, strapping, or splint, only one CPT code for closed dislocation or fracture treatment CPT code may be reported for the anatomic area that would have been treated by a single cast, strap, or splint.
Finally, if a cast, strapping, or splint applied after an open or percutaneous treatment of a dislocation and/or fracture also treats a closed dislocation and/or fracture that did not require manipulation, a CPT code for closed dislocation or fracture treatment (without manipulation) shall not be reported separately.
Based upon the above rules, the only CPT code that can be billed as described in the above post is CPT 28740 one time.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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