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10/23/2003    Mark Sturge, DPM

Billing For Multiple Fractures

Query: Billing For Multiple Fractures


Recently, I saw a patient with 4 fractures of
the foot. I performed the following:
- 1st metatarsal base required an open reduction
internal fixation (ORIF);
- 2nd metatarsal shaft fracture was reduced
during the surgery;
- 3rd metatarsal had a non-displaced shaft
fracture; and
- 4th metatarsal had a non-displaced base
fracture.


Neither the 3rd or 4th metatarsals required
manipulation or active reduction be me during
the surgery. A non-weightbearing BK cast was
applied at the time of surgery. How would I
correctly bill this?


Mark Sturge, DPM
Miami, FL


Codingline Responses: Based on your description,
I would recommend billing this fracture care as
follows:


CPT 28485 (open treatment of metatarsal
fracture, with or without internal or external
fixation, each) for the treatment of the first
metatarsal;


CPT 28475 (closed treatment of metatarsal
fracture; with manipulation, each) for the
second metatarsal;


CPT 28470 (closed treatment of metatarsal
fracture; without manipulation, each) for the
3rd and 4th metatarsal fractures.


Each of these codes carry a 90-day Medicare post-
op period. You would, therefore, not bill any
E/M service codes while providing fracture care
during the 90 days.


Howard Zlotoff, DPM
Camp Hill, PA


For this set of procedures, I would bill CPT
28485 (open treatment of metatarsal fracture,
with or without internal or external fixation,
each) x4.


If significantly less work was needed to treat
the 2nd, 3rd, and 4th metatarsal fractures, then
I would still use CPT 28485, but with "-52"
modifiers to reflect reduced required services.


I would also use "-59" modifier on the 2nd, 3rd,
and 4th metatarsal procedures to indicate
separate sites were involved.


For the diagnosis, I would use ICD-9 825.25
(fracture of metatarsal, closed).


Denise Paige, CPC
Long Beach, CA


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