BILLING 28080 WITH 64787

I know that 64787 is not billable with 28080. But what code could I use? Surgeon did an interspace neuroma excision with implantation of nerve into bone. Could I use 28899 for unlisted? I appreciate the information.

Vickie

Comments

  • edited May 2017
    Vickie,

    According to CPT, 64787 is an add on code to be used in conjunction with 64774-64786. However, according to AAOS 64787 is not included in the global package for code 28080 and when I ran it through CCI edits, the two codes were not bundled. Since the notes in CPT state to use 28080 for the Morton's neuroma and gave no other guidelines I would use code 64787 for the nerve implantation into bone and if denied appeal based on AAOS guidelines and CCI edits.

    Sandi Hamrick, CPC
    Toledo Orthopaedic Surgeons
  • I totally disagree with the answer. An add-on code by definition is not a stand alone code and cannot be used except with the code group it is an add-on to. 64787 is definitely designated as an add-on code only per CPT. Our practice billed it out in error a few times with 28080 and each time the payer denied it because of its not being billed with the correct primary code. I would use unlisted 64999 or 28899 and compare to 64787. Or have the surgeon include a statement supporting the use of a 22 modifier and add it to 28080.

    Debbi Credit COSC

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