General Surgery Coding Alert

10 Tips to Ease Unna Boot Billing


- Published on Sat, Jun 01, 2002

Latest on Unna Boot Code from SuperCoder's General Surgery Coder

Unna boots: Named after a German dermatologist, Paul Gerson Unna. The Unna boot itself is a compression dressing, usually made of cotton with a zinc oxide paste applied uniformly to the entire bandage. The zinc oxide paste in the Unna boot helps ease skin irritation and keeps the area moist. The zinc promotes healing within wound sites, making it useful for burns and ulcers. Some Unna boots also contain calamine lotion, glycerin, castor oil, acasia, and white petroleum.

Tips
Code 29580 includes supplies associated...

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Although the coding itself is straightforward there is only one Unna boot code this does not necessarily mean that reporting this service will be problem-free. An Unna boot is a medicated dressing that surgeons use to treat varicose leg ulcers, which may occur due to increased venous pressure from venous insufficiency or other outflow problems. Unna boots also are used to manage lymphatic edema and sometimes are used for sprains, strains, minor fractures and, sometimes, as a protective bandage for grafts on wound burns.

Application of an Unna boot is reported using 29580 (Strapping; Unna boot), which consists of layering a bandage impregnated with Unna paste (gelatin, glycerin and zinc oxide) on the leg ulcer until the bandage becomes semirigid. The combination of pressure and medication aids the healing process.

Multiple treatments typically are required, usually once a week and sometimes more frequently, says Elaine Elliott, CPC, a general surgery coding and reimbursement specialist in Jensen Beach, Fla.

Tip 1: Only significant and separate E/M services should be reported on the same day as Unna boot application. Because Unna boots are applied during a series of visits, E/M services (for example, an established patient visit) should not be reported when the patient comes for scheduled treatment unless the patient has another problem. In such cases, modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be appended to the E/M code.

The appropriate E/M service code may be reported separately for the initial assessment of the condition that led to the decision to apply the Unna boot.

Note: Most procedures, including Unna boot strapping, incorporate a preprocedure evaluation that involves routine follow-up care. A second diagnosis, although not necessary for Medicare carriers, always is helpful by indicating why the visit was separate and significant.

Tip 2: Bill for supplies separately only if the carrier in question instructs you to do so in writing.

Although casts, [...]

General Surgery Coding Alert
Issue - Jun, 2002
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