Reader Questions: Don’t Report Allograft Separate from 27535, 20692 (December 2010)
Question: Our podiatrist performed a number of procedures during the same operative session: open reduction, internal fixation, and external fixator application to a tibial plateau fracture; allograft application; and external fixator application to the tibial plafond fracture. What CPTs apply for these procedures?
Answer: You might be looking at several procedures, but you can actually streamline your report to two codes. Your primary procedure should list 27535 (Open treatment of tibial fracture, proximal [plateau]; unicondylar, includes [...]
Reader Questions: Modifier 25 Fulfills Job for E/M Encounters (December 2010)
Question: A podiatrist sees a 57-year-old female who’s returning to the office under a 10-day global for a postoperative check following a chemical matrixectomy (11730, Avulsion of nail plate, partial or complete, simple; single). The patient returns for check-up, and towards the end complains of heel pain in the left foot. The physician proceeds to check it out. How should you report this?
Answer: Since the patient’s checkup is under the global period, you’d code 99024 [...]
Reader Questions: Modifier 55 Requires Proper Physician Coordination (December 2010)
Question: My podiatrist saw a patient from a winter vacation in Colorado where she has received foot care from another podiatrist in that area. I’m thinking of appending modifier 55 to a suture removal procedure that my podiatrist did. Is this modifier appropriate?
Answer: Modifier 55 (Postoperative management only) isn’t necessarily wrong, but it may get you into some coding challenges if you’re not careful.
Why: CPT does allow modifier 55 to identify the postoperative management when [...]
Key terms such as “metatarsal osteotomy” and “distal Aiken” can make all the difference.
Podiatrists usually perform double osteotomies to correct a patient’s hallux valgus or bunion. Reporting them could result to a double whammy if you failed to recognize the warning signs pointing to a second procedure for your hallux valgus corrections. How do you handle it?
Probably the best initial step to take is to go back to the basics. Podiatrists and nonphysician practitioners operate [...]
Wound Care: 29580 Is Exclusive To Medically Necessary Unna Boot Application (November 2010)
Discover why E/M and strapping can’t go together as separate codes
Did you know that the Correct Coding Initiative (CCI) bundles Unna boot application to many other comprehensive surgeries (e.g. tendon sheath injections, joint aspiration/injection, etc.)? If you’re pulling your hair from confusion about this and many other questions about coding Unna boot application, the following Q&As should shed you some light on how to code it properly.
Question 1: What Is Unna Boot’s Purpose?
Answer: The New [...]
Incident To: Incident To: Cull Out Deserving Dollars Following These Guidelines (November 2010)
Physician’s authorization of NPP’s services is a rule you can’t miss.
CMS recognizes nonphysician practitioners (NPPs) for payment purposes by reimbursing physicians for services provided “incident to” a physician’s care. However, CMS has made it clear in 2008’s Transmittal 87 that payers will not reimburse these services unless there is documentation authorizing the incident-to service.
You could end up dazed and confused if you don’t fully understand incident-to rules. But you can’t afford not to – Medicare reimburses [...]
You Be the Coder: Bunion Isn’t The Same As Hallux Valgus (November 2010)
Question: I have difficulty differentiating diagnosis of bunions from hallux valgus. Any tips?
Answer: First, a bunion is an enlargement of bone or tissue around the metatarsophalangeal (MTP) joint. A patient who always wears shoes that are too narrow around the toe box is prone to getting bunions.
Contrary to common misconception, bunion and hallux valgus are two different disorders. Although CPT lists bunion procedure codes, such as 28290 (Correction, hallux valgus [bunion], with or without sesamoidectomy; [...]
Reader Questions: 29799 Targets Your Casting Coding Challenge (November 2010)
Question: I heard I can use an unlisted casting code in conjunction with codes from the L30xx series. What are the rules that govern the coding?
Answer: You can submit a casting code to represent the podiatrist’s work in conjunction with codes from the L30xx series. You would report 29799 (Unlisted procedure, casting or strapping) for the casting procedure for custom-made orthotics such as L3000, L3020, or L3030. Most insurance companies prefer two line items for [...]
Reader Questions: 11762, 11730 Partners for Nail Bed Reconstruction (November 2010)
Question: A podiatrist reconstructs the nail bed on a patient’s left toe, and performs avulsion of the nail of the second digit of the right foot. How should I report it?
Answer: You would report the service with 11762-FA and 11730-59-T6. Remember, list modifier 59 (Distinct procedural service) first with the location modifier second.
Update: CPT 11762 (Reconstruction of nail bed with graft) now includes 11730 (Avulsion of nail plate, partial or complete, simple; single). These bundles [...]
Reader Questions: Verrucae Treatments Explained (November 2010)
Question: What are the different treatments for verrucae?
Answer: Your choices range from a variety of treatments. If the patient is on a home treatment regimen, then E/M services may be payable to monitor the treatment course. Applying a home treatment medication in the office is not payable separately from the E/M service.
Destruction of common or plantar warts (a.k.a. varrucae) using office-based medications (such as monochloracetic acid, canthrone, etc.), a CO2 laser and cryosurgery warrant either [...]
