Guidelines: 3 Steps Perfect Your Partial Sesamoidectomy Claim   (July 2010)

Hint: Use of modifier 52 is out of the question.
Does partial sesamoidectomy coding have you scratching your head in confusion? Reporting 28315 alone may not always be your best bet. Follow these three steps to claim success.
Consider the following scenario:
The podiatrist at a practice sees a patient – with history of chronic sesamoiditis (733.99) of the right metatarsophalangeal joint and hammertoe (right third and fourth toes) – for hammertoe correction and sesamoid planing of the metatarsophalangeal joint. [...]

Mythbuster: Sort Out These Suture Removal Facts Against 3 Misconceptions   (July 2010)

Formula: Removal with anesthesia = 15850 or 15851
The bad news: suture removal is usually bundled into the global, so forget about earning that extra revenue by billing it separately. The good news: you can take advantage of basic coding options available that will improve documentation and save you out of compromising situations.
Learn the tricks of the trade by resolving these 3 myths.
Myth 1: 99024 Is a “Trophy” Code
Reality: You think that just because 99024 (Postoperative [...]

FAQs: Put A Stop To Modifier 25 Misuse and Abuse   (July 2010)

Find out why the phrase “by the way” offers an effective insight.
Many podiatry practices take modifier 25 as a go-to modifier whenever patients visit for any checkup or procedure, regardless of whether their situation really justified modifier 25. Usually, the intention is to recoup more reimbursement, says John F. Bishop, PA-C, CPC, president and CEO of Bishop & Associates Inc. in Tampa, Fla. As a result, modifier 25 doesn’t serve its real function.
Ask these 3 [...]

You Be the Coder: Stick It Out With Primary Diagnosis Code   (July 2010)

Question: I heard that when billing 11721, diagnosis code 110.1 needs to be the primary diagnosis code. When billing 11055, the primary diagnosis code should be 700. Assuming the patient has a systemic diagnosis as well, how do you bill both procedure codes on the same claim for same date of service?New York Subscriber
Answer: Assuming you are billing for outpatient provider services, you should bill them on the same CMS 1500 form but you should [...]

Reader Questions: Mention Number of Units in Toe Repair Coding   (July 2010)

Question: A 60-year old patient presented to emergency with a history of a heavy tile falling on his right foot. She has sustained avulsions of the bases of the nails of the great and second toes, which involve both the skin and nail beds of each toe. The podiatrist provides local anesthesia and removes the entirety of each nail, sutures a 1 cm laceration of the skin of each toe and also sutures 1.5 cm [...]

Reader Questions: Set Hallux Rigidus Apart From Arthritis   (July 2010)

Question: The podiatrist performed cheilectomy on the left toe for hallux rigidus. Any suggestions on CPT for bone diagnosis, excisional, first metatarsal?
Arizona Subscriber
Answer: You should use 28289 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint [MTP]) for the hallux rigidus (735.2) diagnosis.
Trap: Many practices confuse hallux rigidus with degenerative arthritis because they are synonymous. The actual cheilectomy surgical procedure is that of removing the bone from the 1st metatarsal [...]

Reader Questions: Look For the Right Q   (July 2010)

Question: I am billing 11721 with the primary diagnosis 110.1 (Dermatophytosis of nail), and other diagnoses 250.60 (Diabetes mellitus), and 443.9 (Peripheral vascular disease, unspecified). I’m curious why Medicare would require a Q modifier?
Mississippi Subscriber
Answer: Medicare requires a Q modifier to determine the extent and  nature of the patient’s health status. If the service involves nail care, then you should append a Q modifier. If it does not qualify then it is probably a cash [...]

Reader Questions: Unlisted Codes Fare Best For Hallux Limitus   (July 2010)

Question: My podiatrist performed a joint replacement for hallux limitus on a patient who does not have a bunion. I think I should use 28293, but my podiatrist thinks otherwise. What is the code to use for this procedure?
Kentucky Subscriber
Answer: Your podiatrist is right to disagree. You will not find a CPT for hallux arthroplasty with implant, and your best option is to useunlisted codes.
Here’s what you should do: report 28899 (Unlisted procedure, foot or [...]

Reader Questions: Pick From 2 Choices When Treating Plantar Nerve Lesions   (July 2010)

Question: A patient, who experiences pain, numbness, and a burning feeling in her in her foot, presents with Morton’s neuroma. The podiatrist administered a steroid injection for temporary relief. I’m not sure what CPT to report. Could you help?
New Mexico Subscriber
Answer: When your podiatrist treats a condition affecting plantar common digital nerves – in this case, Morton’s neuroma (355.6, Lesion of plantar nerve) – you should use 64455 or64632. While 64455 is just your steroid injection for [...]

Reader Questions: Be Able To Tell When To Report 29550 and 20550 Separately   (July 2010)

Question: A podiatrist performs a strapping procedure on the big digit of the patient’s right foot. She also injects a therapeutic agent into the left foot. Should I report 29550 and 20550 as separate procedures?
Colorado Subscriber
Answer: Yes. The CCI bundles 20550 (Strapping; toes) into 29550 (Injections[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]). However, your podiatrist performed the procedures in different anatomic locations, so you can bypass the bundling edit by appending modifier [...]