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12/23/2009    

CODINGLINE CORNER

Query: Hallux Valgus Repair


We are trying to the locate the appropriate code(s) for a hallux varus repair by capsulotomy and Mini-TightRope.


Joy Constanzo, Billing Supervisor, Office of Kirk Koepsel, DPM,

Houston, TX


Response: There is no specific code for this service. You should bill for the actual procedure(s) performed. It this case, your options could include CPT 28270 which is capsulotomy metatarsal-phalangeal joint, or CPT 28313 (reconstruction angular deformity of toes, soft tissue procedure only).


There is no code for the TightRope use. It is a product used in the primary repair procedure. If you feel the work done was significant enough, append a "-22" modifier. The op report should clearly document that work. Be sure to include a letter of explanation.


Tony Poggio, DPM, Alameda, CA


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10/18/2014    

CODINGLINE CORNER


Query: Stage 2 Meaningful Use Hardship Extension


 


After looking at the requirements for the hardship extension, I am thinking of submitting for an extension. This is based on the fact that my EHR company received their certification for Stage 2 around May 1st. With reprogramming and training myself and staff along with computer reconfiguration, establishing a patient portal, etc., and trying to qualify for the 90-day period, we won't make it. I would have no problem meeting Stage 1 again. Any feedback on this idea? 


 


Don Ambroziak, DPM, Lexington, KY


 


Response: Providers that were due for Stage 2 in 2014 can instead attest using Stage 1 criteria if they attest to the inability to fully implement 2014 Edition certified electronic health record technology (CEHRT) due to delays in 2014 Edition CEHRT availability. This includes staff training. It sounds like your situation applies. It's not a bad idea to check with your vendor to see if they will be willing to provide you with proof of their delayed Stage 2 certification. 


 


Jeffrey Lehrman, DPM, Springfield, PA


 



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10/15/2014    

CODINGLINE CORNER


Query: Not Meeting Criteria for Diabetic Inserts 


 


We have a pair of orthotics that qualify for diabetic inserts - Medicare allows approximately $56 per pair if the patient qualifies. If the patient is Medicare but does NOT qualify for coverage and wants to pay out-of-pocket, is there any regulation as to what we can charge the patient? I thought that I had seen (many years ago) that if the item is sometimes covered by Medicare, but in this case it is not - you must charge the patient at least the amount that Medicare would allow. In other words, you cannot give the patient a lower price than you would bill to Medicare. I have tried searching Noridian Medicare and CMS.Gov sites and I cannot find information on this anywhere. Does anyone know if this is still true? 


 


Peyman Elison, DPM, Surprise, AZ


 


Response: If the patient does not statutorily qualify for coverage, then there is no fee schedule limit you are obligated to follow. No advance beneficiary notice is required. You can bill your fees directly to the patient. If, however, the reason the patient does not qualify is not because they medically are not eligible (that's a double negative), but because of medical necessity (e.g., wants a 4th pair of diabetic inserts within a single calendar year), then you would need to have an ABN signed, bill the codes using a "GA" modifier, and bill no more than the fee schedule allowance. I am not aware of any Medicare provision that forbids you from billing less than the Medicare maximum allowance. 


 


Harry Goldsmith, DPM, Cerritos, CA 


 



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10/11/2014    

CODINGLINE CORNER


 Query: Not Meeting Criteria for Diabetic Inserts


 


We have a pair of orthotics that qualify for diabetic inserts - Medicare allows approximately $56 per pair if the patient qualifies. If the patient has Medicare but does NOT qualify for coverage and wants to pay out-of-pocket, is there any regulation as to what we can charge the patient? I thought that I had seen (many years ago) that if the item is sometimes covered by Medicare, but in this case it is not - you must charge the patient at least the amount that Medicare would allow. In other words, you cannot give the patient a lower price than you would bill to Medicare. I have tried searching Noridian Medicare and CMS.Gov sites, and I cannot information on this anywhere. Does anyone know if this is still true? 


 


Peyman Elison, DPM, Surprise, AZ 


 


Response: If the patient does not statutorily qualify for coverage, then there is no fee schedule limit you are obligated to follow. No advance beneficiary notice is required. You can bill your fees directly to the patient. If, however, the reason the patient does not qualify is not because they medically are not eligible (that's a double negative), but because of medical necessity (e.g., wants a 4th pair of diabetic inserts within a single calendar year), then you would need to have an ABN signed, bill the codes using a "GA" modifier, and bill no more than the fee schedule allowance. I am not aware of any Medicare provision that forbids you from billing less than the Medicare maximum allowance. 


 


Harry Goldsmith, DPM, Cerritos, CA 


 



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10/08/2014    

CODINGLINE CORNER


Query: Codes Not Covered by Medicaid


 


Our practice bills Medicaid as a secondary insurance to Medicare and Medicare Advantage Plans. Medicaid would usually pick up the 20% balance after Medicare and/or pick up the co-pays for the Medicare Advantage Plans for procedure codes, CPT 11719, CPT 11055, CPT 11056, and CPT 11057. According to the April 2014 Medicaid Update, however, as of June 1, 2014 if these procedure codes are not on the Medicaid fee schedule, then Medicaid will not pick up the balance or co-pays. Does anyone know of any codes that will cross over to Medicaid for these non-covered codes by Medicaid? Or do we have to write off the balance after Medicare? Can we opt out of Medicaid? 


 


Dawn Dryden, DPM, Batavia, NY


 


Response: Yes, you can opt out of Medicaid. Beware, however, if you do that, then you may not also be able to participate in many (not all) Medicaid managed care plans which pay close to Medicare rates. You might want to call New York State Medicaid for advice. In the past, they informed me to crossover the codes to something which closely resembles the codes that are not being paid. Not exactly a definitive answer, leaving much to interpret. They, however, would be the 'go-to' source. 


 


Paul Kesselman, DPM, Woodside, NY 


 



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10/04/2014    

CODINGLINE CORNER


Query: Re-Evaluating At-Risk Status


 


If a qualified routine nail care patient returns to the office for a follow-up nail debridement (CPT 11721-Q8) in one year as opposed to just over two months, do they qualify for a low level E/M (CPT 99212) in addition to the debridement, if a reassessment is performed? That is to say, what is the period of time that has to elapse to be allowed according to Medicare guidelines? 


 


Charles Perry, DPM , Cambridge, OH


 


Response: Evaluating your diabetic patients periodically is good medical practice. The time frame, whether it is every three, six, or twelve months or longer, should be based on your patient's overall symptoms and medical necessity. Coding for that visit would need to be based on either the 1995 or 1997 CPT E/M guidelines. 


 


With regard to performing both an E/M and a CPT 11721 (or other covered routine foot care service) on the same date-of-service could be problematic. Most LCDs used to say (and may well still do) that you cannot perform an E/M on the same day as a covered palliative foot care service for the purpose of qualifying or re-qualifying that patient for coverage. So I suggest, for that reason, that you not do so. Rather, I recommend bringing the patient in for the sole and express purpose of evaluating their overall and specifically their lower extremity status with regard to their diabetes. This is something that has been espoused by others well before this e-mail response and is nothing new to our profession. 


 


Paul Kinberg, DPM, Dallas, TX 


 



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10/01/2014    

CODINGLINE CORNER


Query: Billing Ulcer Debridement with Follow-Up Hospital Care


 


My doctor has had to hospitalize a couple of our patients due to severe ulcers. He takes them to the operating room for debridement, usually billing CPT 11043 or CPT 11044. He then bills for subsequent hospital visits, CPT 99232 or CPT 99233, when following up and inspecting the ulcers over the next few days. Per the APMA Coding Resource Center, both CPT 11043 and CPT 11044 have no global periods assigned, but we are getting denials both from Medicare and Blue Cross on our hospital visits, stating the patient is in the global period. I am assuming we are billing something incorrectly. Any help would be greatly appreciated. 


 


Billing Office of Thomas Fitzgerald, DPM, Rohnert Park, CA 


 


Response: You are correct -- there is no global period for any of the surgical debridement codes, CPT 11042, CPT 11043, CPT 11044.  The doctor performs CPT 11044 in the hospital a lot and also bills CPT 99232 or CPT 99233 the day before or the day after. We are not having any issues with our Medicare carrier or Blue Cross Blue Shield (BCBS) contractors. You might want to call your Medicare carrier or BCBS and find out what specifically they are denying the claim against. 


 


Jennifer -- Billing Specialist, Mid-South Foot & Ankle Specialists, Cordova, TN 


 



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09/27/2014    

CODINGLINE CORNER


Query: Coding Extensor Tendon Repair with Graft 


 


When billing CPT 27665 (repair, extensor tendon, leg; secondary, with or without graft, each tendon) with graft, is there a billable charge for the actual harvest of that graft from another remote site like an autogenous graft from the Achilles tendon to the anterior tibial tendon? 


 


Robert Anderson, DPM, Brewer, ME


 


Response: When billing for a tendon repair with graft, the harvesting of graft is included in the code. You should not be billing for obtaining the graft, even if from a remote site. 


 


Howard Zlotoff DPM,Camp Hill, PA 


 



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09/24/2014    

CODINGLINE CORNER


Query: PRP Injection Payment Losses


 


Is anyone successfully billing for PRP Injections without a direct loss to your practice? Our physician has a patient who is a good candidate for this conservative treatment. The PRP rep charges $200 for the kit used to perform this service. UnitedHealthcare, however, states their reimbursement rate is only $53.17 for 0232T. As the office manager and coder, how can I justify a $146.83 loss for a procedure? 


 


Terri Phillips, CPC, Tulsa, OK


 


Response: I suggest contacting UnitedHealthcare (do it in writing) and ask them if they're expecting you to bill the PRP kit as a separate supply the same way you do for the drugs involved in joint or tendon injections. At that payment rate (which looks like it's close to or possibly even less than what they'd pay for a tendon injection with a steroid), I'm guessing they're expecting you to bill separately for the supply. 


 


If that's the case, you'd use A4649 (surgical supply; miscellaneous) and include a copy of the invoice so they can see what your acquisition cost is for the PRP kit). But check with UHC and see if that's what they're expecting you to do. Also, I wouldn't "assume" that the kit is excluded for your other payers, though. I think this is probably one of those things you'll need to investigate on a payer-by-payer basis. 


 


Joan Gilhooly, CPC, CPCO, Lebanon, OH 


 



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09/20/2014    

CODINGLINE CORNER


Query: Revisiting Subtalar Arthroereisis Coding


 


Are there any new or "other" codes for subtalar arthroereisis (or any other names the procedure is being called) aside from CPT 28899, S2117, or 0335T? 


 


Mark Bauman, DPM, Marlton, NJ


 


Response: The answer to your question is "NO" - there are no new codes. The 3 you listed, CPT 28899, S2117, CPT 0335T, are your only options. 


 


David J. Freedman, DPM, CPC, Silver Spring, MD


 



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09/17/2014    

CODINGLINE CORNER


Query: CPT 11750 vs CPT 11765


 


One of my providers did a Winograd procedure (matrixectomy) on a right great toe (outpatient at a hospital). He is wondering if he performed the procedure on both the medial and the lateral borders - and he has it detailed in his operative report - can we bill more than 1 unit? The way his report reads, the nail was removed, so I would use the CPT 11750 instead of the CPT 11765. But my understanding of CPT 11750 is that it can only be billed 1 unit per toe per day. 


 


Jennifer P. - Billing Specialists, Office of Jennifer Hardee-Powell, DPM, Memphis, TN


 


Response: CPT 11765 is a "wedge excision of skin of nail fold (e.g., for ingrown toenail)." This procedure, when performed, does not touch the nail or the nail matrix. It excises a wedge of hypertrophic skin ("proud flesh") thus pulling the remaining hypertrophic skin off the nail. This procedure is, to the best of my knowledge, never (or hardly ever) performed anymore, as there are other efficacious ways to resolve an ingrown nail. The Winograd and other "cold steel" surgical nail procedures fall under the same code as a phenol or other permanent excision of nail. The code verbiage says partial or complete. 


 


Most podiatrists bill the medial and lateral nail Winograd nail excisions using CPT 11750 with "1" unit. However, there are some coders who would tell you to try billing the procedures twice on two separate lines. The first CPT 11750-T_ and the second CPT 11750-T_-59. Nothing ventured, nothing gained, but don't be surprised if the insurance company denies the second procedure. 


 


Paul Kinberg, DPM, Dallas, TX 


 



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09/15/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



 


It is fortunate for some that we do not use this logic for reimbursement of a surgical procedure. To carve down fees based upon the cost of the actual amount of suture and length of the suture used is equally as erroneous. True, the procedure fee is separated from one's costs vs. one's fees. If equal types of material(s) and professional components are utilized, then shouldn't there be an equal fee and reimbursement? 


 


Steven J. Kaniadakis, St. Petersburg, FL, owner@ametex101.com

09/13/2014    

CODINGLINE CORNER


Query: Billing for Dexamethasone


 


What is the proper way to bill for dexamethasone phosphate? The price of the 30 ml bottle is $21 and I'm getting reimbursed 15 cents for J1100. This is not a good return on my investment. 


 


Stephen Bennett, DPM, NY, NY


 


Response: Let's do the math. J1100 or dexamethasone phosphate - a unit is 1mg. The bottle typically says 4mg/ml. So, if you inject 0.25cc you are injecting one unit; 0.5cc=2 units; 0.75cc=3 units; and 1.0cc=4 units. Typically the dexamethasone phosphate is purchased in a multiuse vial - 30ml. That means if you are getting reimbursed 15 cents per unit and a unit is 0.25cc, then your 30 ml vial will get you $18.00 reimbursed. 


 


It sounds like you are paying too much from your vendor. It's time to price-shop. It's costing you money to inject the product. There is no return on investment. Think of an alternative injectable if you can't find it for less than $18 a 30ml multidose vial! 


 


David J. Freedman, DPM, CPC, Silver Spring, MD

09/10/2014    

CODINGLINE CORNER


Query: CMS Flexibility in Meeting Meaningful Use


 


I am in my 4th year of reporting Meaningful Use, and I am scheduled to report Stage 2 this year(2014). I use Practice Fusion as my EHR. It is 2014 certified. I was under the impression (according to various sources) that I have the option of reporting Stage 1 this year under the new CMS final rule if I attest that I have not been able to fully implement Stage 2 into my practice work flow despite having 2014 certified technology. Is this still true under the final CMS rule? Is this rule officially effective yet? 


 


Ronald Oberman, DPM, Deerfield Beach, FL


 


Response: The rule has been finalized. You are correct about being able to report Stage 1 2014 objectives and quality measures (there are also other options using 2011 CEHRT or a combination of the two) if you can attest to not being able to fully implement the 2014 CEHRT. 


 


However, and this is the key, the inablility to fully implement the 2014 CEHRT must be related to delays in availability of the software. If you are going to attest to this, I recommend that you have something in writing from Practice Fusion indicating that there were delays in making the 2014 CEHRT available to their subscribers. Otherwise, if you are audited and cannot document that there were delays in availability, you could have problems. The entire final rule is posted on the CMS website and does cite some examples as to what constitutes inability to fully implement 2014 CEHRT. 


 


Jim Christina, DPM, Bethesda, MD 


 



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09/10/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Dennis Shavelson, DPM


 


I realized that I was out of bounds in my posting regarding neuroma injection codes and that I lack the necessary credentials to relate their use to fraud.


 


Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com

09/09/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Dennis Shavelson, DPM


 


There are two codes for injecting sclerosing alcohol perineurally as treatment for neuromata. CPT 64455 is used when the concentration of alcohol is less than 30%, and CPT 64632 is used when the concentration of alcohol is greater than 30%. Steinberg’s/Dockery’s “mild sclerosing solution” is used multiple times and uses reverse angiogenesis for lesions such as neuromata, soft corns, etc. This is coded CPT 64455.


 


When dealing with intractable, end-stage neurogenic pain and the need for neurolysis, chemical ablation, or permanent destruction of a nerve in lieu of a neurectomy in cases of nerve injury or chronic pain syndromes, toxic levels of alcohol or phenol are injected and properly coded as CPT 64632. In general, no more than one or two treatments are necessary, and this is rarely needed when treating neuromata. The use of CPT 64632 as a code for a 0-29% alcohol injection or when discussing anything but ablation or denervation with patients deserves investigation as insurance fraud.


 


Dennis Shavelson, DPM, NY, NY, drsha@lifestylepodiatry.com

09/06/2014    

CODINGLINE CORNER


Query: Billing for Injection of Morton's Neuroma


 


My doctor uses CPT 64632 (destruction by neurolytic agent; plantar common digital nerve) for administering an injection of dehydrated alcohol into a Morton's neuroma. After getting paid barely enough to cover the cost of the ampules, I did some research and found J3490 (unclassified drug) can be used when there is no CPT for the injectable. Has anyone used J3490 and been successful in getting paid? If so, was there any modifier that had to be used? 


 


Yvette H. Office of Richard DiMario, DPM, York, ME


 


Response: Check your contractor's LCD, but J3490 (unclassified drug) is a descriptive code here and not payable. I believe you are using the correct code for the injection of dehydrated alcohol. You didn't indicate if you are using the second code for the injection. If you are not using it, please do. There are two separate injection codes for Morton's neuroma: one for injection (CPT 64455) and one for destruction (CPT 64632). 


 


Lisa Merkow, CPC, Largo, FL


 



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09/03/2014    

CODINGLINE CORNER


Query: Getting Reimbursed for an MLK F1 Kit


 


A provider of ours has been approached by a salesperson of the MLK F1 kit. Their recommendation is to bill this as J3490 (unclassified drugs). Their sample claim shows a fee of $583 for this combo: lidocaine, Marcaine, Kenalog, and povidone iodine kit. Is anyone using this kit and having any luck with reimbursement? Will the combining of these medications into a pre-packaged kit have a synergistic effect on the reimbursement amount? 


 


Ursula Smith, Lake Mary, FL  


 


Response: Lidocaine and Marcaine are inclusive in whatever surgical procedure these local anesthetics are used. The povidone iodine swabs are considered routine office/routine surgical supplies and are not separately reportable either. The nitrile gloves, the bandage, and the non-sterile 4x4 gauze pad are routine office/surgical supplies that aren't separately reportable either. Literally, the only thing in the "kit" that is separately billable is the Kenalog (J3301 - triamcinolone acetonide, per 10 mg). You can only bill for the number of units of that drug that you actually use, even though the multi-use vial included in the kit includes a total of 200 mg. 


 


It would be totally misrepresenting the billable medications used to attempt to report this "kit" using J3490 (unclassified drugs) since the only thing in the "kit" that is separately billable already has an existing HCPCS code. Additionally, a "sample charge" of $583 is...., well, it's unbelievable. The only separately billable drug that's being used (the Kenalog) reimburses $1.82/10 mg dose. Thank goodness you had the good sense to check into this further. Ignore what the manufacturer is telling you and simply bill for the Kenalog you use. Hopefully the "kit" costs less than it would cost you to separately order the rest of the non-billable supplies. 


 


Joan Gilhooly, CPC, CPCO, Lebanon, OH 


 



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08/30/2014    

CODINGLINE CORNER


Query: E/M Bullet Points for Exam


 


When counting the bullet points for an exam to determine what office visit level to code, does each limb count as a bullet point? I'm being told by my billing office that the only time that bilateral counts is for the musculoskeletal. So, a vascular palpation of DP/PT pulses either on one or both feet counts as only one bullet. Is this correct? Can someone lead me to the place to read the exact definition? 


 


Theresa Hughes, DPM, Galesburg, IL


 


Response: Your billing office is correct. You'll want to look at the musculoskeletal exam in the 1997 E/M guidelines. They can be found starting on page 32 of this pdf file


 


Joan Gilhooly, CPC, CPCO, Lebanon, OH 


 



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08/27/2014    

CODINGLINE CORNER


Query; Help Coding Neuroma Injections 


 


I would appreciate help with how to get paid for injections of more than one neuroma administered on each foot. Currently, most insurance plans are only allowing for payment for one of the two injections that I give. For example, if I place cortisone injections in the left foot 2nd and 3rd intermetatarsal spaces, they are only paying for one injection (CPT 64455), saying that the other injection is included with that payment. This is also happening with sclerosing injections (CPT 64632). 


 


Danny Albertson, APRN, London, KY 


 


Response: The answer to this question is in the definition of the steroid neuroma injection code(s). It states injection(s) meaning one or more in the same foot. The terminology was a concession that was made when the neuroma injection codes were developed at CPT. Injection of the second foot would be allowed, but will be subject to the multiple procedure discount. 


 


Phill Ward, DPM, APMA CPT Advisor, Durham, NC


 



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08/23/2014    

CODINGLINE CORNER


Query: Which Takes the *-59* Modifier


 


When billing CPT 11719, CPT 11721 and CPT 11056 together, which one gets the "-59" modifier? 


 


Robert Bello, DPM, Garden City, NY 


 


Response: You are not allowed to bill CPT 11719 and CPT 11721 on the same day on the same patient. 


 


When billing CPT 11721 and CPT 11056, assuming that all of the requirements for routine foot care have been met, the "-59" modifier would be appended to the CPT 11721. 


 


Robert Weatherford, CPC, Jacksonville, FL


 



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08/20/2014    

CODINGLINE CORNER


Query: Bandages Dispensed During Visit


 


I have a Medicare patient who qualifies for bandages, according to the Florida LCD, and does not have home healthcare. So, I am dispensing those bandages while the patient is in the office. So if I bill for a debridement in the office, can I bill for bandages with POS 12 for home use on the same day as the debridement (POS 11)? The bandages will be used by the patient the next day at home. 


 


Marc Katz, DPM, Tampa, FL 


 


Response: You will need to look at the carrier's LCD on surgical dressings to see if the wound itself qualifies for a surgical dressing, which type of dressing, and how many dressings you may dispense per month. If the patient is not on Medicare, surgical dressing coverage may be carved out to a third-party DME commercial supplier. In addition, you need to see if the patient otherwise qualifies. If they are on VNS services and/or receiving home healthcare from Medicare, you would not be reimbursed by Medicare (or possibly even other third-party payers). 


 


Paul Kesselman, DPM, Woodside, NY 


 



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08/16/2014    

CODINGLINE CORNER


Query: E/M Code with CPT 11721


 


I was wondering how significantly separate an E/M should be to bill it in addition to CPT 11721. My provider always performs a foot exam on a patient who receives nail debridement services which is understandable because most of the time the "Q" modifier needs to be met. The provider does not bill for this exam separately. 


 


However, my question pertains to when the patient arrives for nail debridement services, and during this routine foot exam is found to have tinea pedis in between the toes (for example). The doctor will usually prescribe a cream and bill an E/M for this service. I am conflicted with billing the separate E/M because my provider always performs the same foot exam, and the only thing different is giving a prescription for the patient's tinea pedis. Any thoughts or opinions? 


 


Hollie Gunderson, CPC, CSFAC, Holland, MI


 


Response: The "at risk" foot exam you refer to that is performed with each nail debridement service is not a separately identifiable E/M service. 


 


However, the situation you describe with tinea pedis is separately identifiable from the nail debridement procedure if it meets the standards for an E/M, taking into consideration the need for 2 of the 3 three key components (for an established patient): history, exam, and decision-making. Certainly, those criteria are met in taking the medical/problem history, examining the feet, and diagnosing/managing the tinea pedis. This service should be separately identifiable from the nail debridement. I would code the appropriate level E/M with a "-25" modifier. 


 


Jeffrey Lehrman, DPM, Springfield, PA


 



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08/14/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Steven J. Kaniadakis, DPM


 


In a response to Dr. Andrew Resler's post, it was for this reason that I invented a specially designed electronic super-bill, which helps solves this and other problems. The priority (ICD) diagnosis is one that only the treating provider knows should be used with the product or service provided. It should not be a billing/coding person who makes the primary diagnosis. A problem with current electronic superbills, as well as old paper ones, includes that they do not all offer methods to match CPT and/or HCPCs with ICD code numbers and descriptions.


 


The super-bill enables the treating provider to actually place the ICDs in a priority sequence, so the (primary position) first one listed takes priority, and it is adjacent to the CPT/HCPCS code rendered and/or dispensed. Secondary, tertiary, and other diagnosis codes are taken into consideration by others. Medicare only looks at the first one listed. Often billers and coders, even experts, only look at the first ICD with a given CPT/HCPCS code. So, it is a very prime position which deserves attention by the treating provider.


 


Steven J. Kaniadakis, DPM, St. Petersburg, FL

08/13/2014    

CODINGLINE CORNER


Query: What Diagnosis Goes First? 


 


For routine foot care in New York, what comes first in the order of the diagnosis codes when you are billing for diabetes WITH a qualifying condition: the diabetes code (ICD-9 250.6_ or ICD-9 250.7_), the nail code (ICD-9 110.1) or the hyperkeratosis code (ICD-9 701.1)?  Of course, we know that the date the patient last saw their treating physician must be included. The reason I ask is that I used to always bill the diabetes code first, then started getting rejections about 3-5 years ago and was told the diabetes code goes last. Now I have ONE patient that Medicare will not pay on stating that the diabetes code must come first and this happened on this ONE patient for 2 claims. All other patients have been paid using diabetes diagnosis last! 


 


Andrew Resler, DPM, New Windsor, NY


 


Response: I have never seen a health plan require a supporting diagnosis be listed first on a CPT/HCPCS that is being billed. I recommend going back to the claim and look at the remark codes to see if there is a different reason for the denial. Logically, you list the REASON first for the CPT you are billing, and the supporting reason next. Hence, if you are trimming/debriding nails - say WHY they need the trimming/debriding *first* - then the required supporting diagnosis (systemic disease). And, of course there are qualifying modifiers. 


 


Karen Hurley, CMM, CPC, Lakewood Ranch, FL 


 



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08/09/2014    

CODINGLINE CORNER


Query: Refunding an Overcharge for a Deceased Patient


 


We have a married couple who were both patients here at our office. The wife has since died, but her husband is still a patient. The wife is due a refund from a copay that was overpaid. The patient's husband stated there is no estate and he is not the power of attorney for his wife. Is it legal to make the check out to the husband's name and/or transfer the refund the husband's account? 


 


Dawn Dryden, DPM, Batavia, NY


 


Response: PM News does not provide legal advice.  In New York, if there is a Will, it must be probated, likely giving the husband the power to pay debts and receive an income due her. If there is no Will, the estate will go the husband. If the decedant had less than $30,000 in personal property, the husband can file a simple small estate affidavit, which would allow him to collect this sum from you. 


 



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