Billing

Proper Billing for Finger and Toe Procedures

When billing for procedures that are performed on the fingers and/or toes, it’s essential to append the appropriate anatomical modifier for the service rendered. This allows the patient history to identify which finger and/or toe the procedure was performed on.

Claims submitted without the appropriate anatomical modifier may not be payable, as there is no identifier to indicate if the procedure is a repeat, or a duplicate.

Properly billing for these services will help avoid unnecessary denials, requests for appeals to correct denied claims, and assist providers in avoiding Medically Unlikely Edit scenarios that lead to claim denials. 

Centers for Medicare & Medicaid Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Section 20.9.3.2 states “Providers or suppliers shall use anatomic modifiers (e.g., RT, LT, FA, F1-F9, TA, T1-T9, E1-E4) and report procedures with differing modifiers on individual claim lines when appropriate. Many MUEs are based on the assumption that correct modifiers are used.”

Reviewed 11/3/2023