Query: Bundled Codes
The doctor performed CPT 28313-T9 (reconstruction, angular deformity of toe, soft tissue procedures only) with a diagnosis code of ICD-9 735.4 (hammertoe), and CPT 28234-51-RT (tenotomy, open, extensor, foot or toe, each tendon) with a diagnosis code of ICD-9 754.89 (other specified nonteratogenic anomalies; example: generalized flexion contractures of lower limb joints, congenital).
The insurance company denied the second procedure as bundled into CPT 28313 even though separate incisions were made. Can someone tell me if these codes are bundled, and, if not, what documentation I can submit to get it paid?
Denise Merrick, North Las Vegas, NV
Response: Performing procedure through separate incisions has no bearing on whether the procedures billed are to be independently reimbursed. The key is whether or not they are components of a more comprehensive code, or one procedure is bundled into one of the other codes billed.
The CPT 28313 procedure is pretty comprehensive when it comes to soft tissue correction of angular deformities of a toe. If a tight or contracted tendon results in the digital angular deformity, its release would be included (bundled) into CPT 28313.
Tony Poggio, DPM, Alameda, CA
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