Confused about CPT Code 26600

Question:

I am confused on how to report the closed treatment of multiple metacarpal fractures (26600) that are not displaced and treated with the application of a fiberglass short arm cast.    We are receiving denials when reporting the code for each fracture.

Answer:

The official definition of CPT code 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) instructs the physician to report CPT code 26600 for each bone that is fracture and treated without manipulation.

Several years ago, CMS implemented NCCI guidelines instructing that non-manipulative fractures that are treated with a single form of stabilization (e.g. cast) may only be reported as a single fracture.  This NCCI guideline also applies to situations where a patient may have both a displaced and non-displaced fracture treated with the same cast or splint.

The denials are correct if the payor is Medicare based on NCCI edits.  If the denials are coming from private payors, review the contracts to determine if the claim processing rule is agreed to in the contracts.  Appeal all denials to private payors citing CPT rules and hopefully contract agreement language.

*This response is based on the best information available as of 05/31/18.