How To Use CPT Code 28470

CPT 28470 describes the closed treatment of a metatarsal fracture without manipulation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28470?

CPT 28470 is used to describe the closed treatment of a metatarsal fracture without manipulation. This means that the provider treats the fracture without making a skin incision or manipulating the fracture. Instead, they confirm the location of the fractured bones using X-rays and apply a brace, cast, or splint to the fractured site along with the lower leg.

2. Official Description

The official description of CPT code 28470 is: ‘Closed treatment of metatarsal fracture; without manipulation, each.’

3. Procedure

1. The provider performs X-rays of the metatarsal bones of the foot to confirm the location of the fractured bones.
2. After confirming that the fractured bones are in good alignment, the provider applies a brace, cast, or splint to the fractured site along with the lower leg.

4. Qualifying circumstances

CPT 28470 is used for the closed treatment of a metatarsal fracture without manipulation. This code is appropriate when the provider does not make a skin incision or manipulate the fracture. It is important to note that any initial splint or cast is included in the payment for CPT 28470 and cannot be billed separately. Any subsequent visits relating to the fracture are included in the global period. Additional supplies of casting materials can be reported using HCPCS codes.

5. When to use CPT code 28470

CPT code 28470 should be used when the provider performs the closed treatment of a metatarsal fracture without manipulation. It is important to note that the word “each” with CPT code 28470 means each metatarsal. For example, if the left 2nd and right 4th metatarsals are fractured, CPT code 28740 should be assigned twice, once for the closed treatment of the left 2nd metatarsal and once for the closed treatment of the right 4th metatarsal fracture with appropriate LT and RT modifiers appended.

6. Documentation requirements

To support a claim for CPT code 28470, the provider must document the following information:

• Patient’s diagnosis and the need for closed treatment of the metatarsal fracture
• Confirmation of the location of the fractured bones using X-rays
• Date of the treatment
• Details of the treatment provided, including the application of a brace, cast, or splint
• Signature of the provider

7. Billing guidelines

When billing for CPT code 28470, it is important to ensure that the treatment does not involve manipulation of the fracture. Any initial splint or cast is included in the payment for CPT code 28470 and cannot be billed separately. Any subsequent visits relating to the fracture are included in the global period. Additional supplies of casting materials can be reported using HCPCS codes.

8. Historical information

CPT code 28470 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient presents with a fractured 3rd metatarsal. The provider performs X-rays to confirm the location of the fracture and applies a cast to the fractured site along with the lower leg.
2. A patient sustains a fractured 5th metatarsal. The provider confirms the location of the fracture using X-rays and applies a brace to the fractured site along with the lower leg.
3. A patient fractures their 2nd and 4th metatarsals. The provider performs X-rays to confirm the location of the fractures and applies a cast to the fractured sites along with the lower leg.
4. A patient fractures their 1st metatarsal. The provider confirms the location of the fracture using X-rays and applies a splint to the fractured site along with the lower leg.
5. A patient presents with a fractured 2nd metatarsal. The provider performs X-rays to confirm the location of the fracture and applies a cast to the fractured site along with the lower leg.
6. A patient sustains a fractured 4th metatarsal. The provider confirms the location of the fracture using X-rays and applies a brace to the fractured site along with the lower leg.
7. A patient fractures their 1st and 3rd metatarsals. The provider performs X-rays to confirm the location of the fractures and applies a cast to the fractured sites along with the lower leg.
8. A patient fractures their 2nd metatarsal. The provider confirms the location of the fracture using X-rays and applies a splint to the fractured site along with the lower leg.
9. A patient presents with a fractured 4th metatarsal. The provider performs X-rays to confirm the location of the fracture and applies a cast to the fractured site along with the lower leg.
10. A patient sustains a fractured 5th metatarsal. The provider confirms the location of the fracture using X-rays and applies a brace to the fractured site along with the lower leg.