28470 and 27786

Have a patient with Fx to lateral malleolus (27786) and also 5th metatarsal (28470) on same side.  Treatment was short leg cast and crutches. return 2 weeks. 

Why does 28470 bundle with 27786?  It asks for a 59 mod even though it is different site. 


Thanks


Comments

  • If you are billing Medicare or payor who follows NCCI then the following applies:

    Medicare NCCI- 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 should 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 should 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) should not be reported separately.
  • Thanks.  This is the reasoning I was thinking but had never come across a bundling scenario  where the fractures were totally separate as in a distal fibula and metatarsal.  It makes perfect sense just wanted to be sure.   
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