Q: Why does CPT Assistant recommend for a scarf osteotomy, but then has “scarf” listed as an eponym for 28295?
A: The scarf osteotomy refers to the shape of the cut, so could be reported with either code depending on where the cut is made on the MT.
Q: Is modifier 59 still necessary even if the “separate procedure” does not have an NCCI bundling edit with the other procedure performed?
A: Yes, the CPT guidelines are clear in direction on how to report separate procedures. The 2020 CPT Official Guideline is: When a procedure or service that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific “separate procedure” code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries).
Q: Would modifier RT OR T5 be used with CPT 28297 when done on the right great toe?
A: Modifier RT would be correct since the actual toe or phalanx is not being treated, the correction is done on the metatarsal and tarsal.
**The coding information and guidance in this post are valid at the time of publishing. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
Deanna Upston, CPMA, CPC, COSC
Deanna is a consultant for The Haugen Consulting Group with over 20 years of health care industry experience. Her introduction was through medical assisting, which she enjoyed for several years. Once she was established at a surgeon’s office, she started coding their surgical cases and discovered that was her favorite part of the day. Deanna has experience working on the professional fee side of coding, audit, education and compliance serving coders and physicians. She has put together multiple education sessions for both provider and coder. She also has experience working as an analyst in which she validated the integrity of editing logic during the implementation of claim scrubbing software.