Question: When does a physician need to obtain a biopsy for skin lesions? What would be the rationale for the decision?
Answer: Sometimes, skin lesions are difficult to diagnose as physicians often see an unclear clinical picture. When faced with this dilemma, a physician usually decides to perform a biopsy. If you’re billing a biopsy of skin and subcutaneous tissues, you should refer to 11100 (Biopsy of skin, subcutaneous tissue and/or mucous membrane [including simple closure], [...]
Reader Questions: 11719-11721 Lets You Supervise Nail Treatments Smoothly (November 2010)
Question: How do you handle coding for common nail conditions?
Answer: First, you should know the difference between nail trimming and nail debridement. Trimming of a nail is a procedure that is intended to reduce only the length of the nail. Your podiatrist can perform this service on a normal nail or a dystrophic nail. Meanwhile, debridement of a nail is a procedure that is intended to remove excessive material (e.g., to significantly reduce nail thickness/bulk) [...]
Reader Questions: 29450 Seals the Weekly Casting Deal (November 2010)
Question: Which modifier should we report when we recast a patient each week to treat his bilateral clubfeet? Illinois Subscriber
Answer: For weekly castings, you should report 29450 (Application of clubfoot cast with molding or manipulation, long or short leg), and append modifier 50 (Bilateral procedure) to it. You don’t need to append another modifier to 29450 because insurers don’t assign global surgical periods to casting codes.
Correction: Bust 2 Myths to Solve Your Os Trigonum Diagnostic Workup Claims (November 2010)
The September 2010 Podiatry Coding Alert article on os trigonum diagnostics (p. 65) contained errors. The ICD-9 code for accessory bone of the foot is 755.67 (Congenital anomalies of foot not elsewhere classified), and not 872.62 (Open wound of ossicles uncomplicated).
Case Study: 11420: 3-Step Guideline to Mark Your Lesion Excision Report (October 2010)
Lesion and margin measurements dictate your reimbursement — find out why.
Sometimes the reports you receive from your physician/surgeon only leaves you confused on what codes to use in your claim. Resolve this dilemma by reading through the documentation with scrutinizing eyes, and you’d be able to determine the appropriate codes and areas for clarification in no time. Examine the following op note:
Preoperative diagnosis: Unknown soft tissue mass, left foot
Postoperative diagnosis: Unknown soft tissue mass, [...]
Fracture Care Coding: 29550 Gives More on Reimbursements Than 28490 (October 2010)
Upgrade your fracture care coding using 4 wise tips.
How can you tell if a claim merits a fracture care code or an E/M code? It’s usually hard to tell right away as experts agree that code selection will likely depend on a case-to-case basis. But you wouldn’t face a cul-de-sac if you could take the following 4 factors into account to find the best fit the fracture treatment.
1. Match Fracture Treatment with Criteria
You’d know [...]
Modifier: Modifier 25 Proves Handy in These 2 Scenarios (October 2010)
HEM and OBTW are important acronyms you should remember. What do they mean?
If you’re dreading an unwanted visit from your auditor or the Office of Inspector General (OIG), you should begin to pay close attention to your methods of appending modifier 25. Test yourself on the proper application of this modifier with the following scenarios.
Stick to the Basics of History, Exam and Medical Decision-Making
Scenario 1: A podiatrist examines an established patient suffering from pain in [...]
Reader Questions: Here Comes the Latest CCI Edits (October 2010)
Question: A coder in my practice is asking me a lot of questions about CCI Edits 16.3. What should we expect with the version 16.3, which recently came out?
Alaska Subscriber
Answer: First, the basics. The National Correct Coding Initiative edits contain a list of CPT or HCPCS Level II codes that are not separately payable, except under certain circumstances, when performed with certain procedures. The edits found in version 16.3 takes effect on Oct. 1, and [...]
Reader Questions: 76942: Remember Guidance When Coding Nerve Block or (October 2010)
Question: A patient who presented with Morton’s neuroma underwent a destruction of plantar digital nerve procedure. How should I bill the claim if the podiatrist used ultrasonic guidance for the destruction?
Florida Subscriber
Answer: If your podiatrist used ultrasonic guidance for either the nerve block (64455, Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [e.g., Morton's neuroma]) or destruction (64632, Destruction by neurolytic agent; plantar common digital nerve), you should add 76942 (Ultrasonic guidance for needle placement [...]
Reader Questions: 17110 Doesn’t Limit Location for Bilateral Verrucae (October 2010)
Question: My podiatrist diagnosed a patient with bilaterial verrucae. She treated two sites (one for each foot). Should I bill 17110 and use the left (LT) and right (RT) modifiers?
Hawaii Subscriber
Answer: That’s a no-no. Location should not matter when you’re coding 17110 (Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions), which includes treatment of wart number one through [...]
