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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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Other messages in this thread:


07/25/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1B



From: Michael Forman, DPM


 


Dr. Ron Freireich asked about the cloning of notes. I agree with him. Things are what they are. If you describe a condition and it is the same, why not use the same words? The same holds true for the past medical history.  Unless something happened from the time you last asked, the past medical history is going to be the same. We have not yet perfected time travel. If you provide the same treatment, the note is going to be the same. 


 


On the other hand, if there is a change, we are obligated to note that change. I still remember Dr. Gerard Yu's comment about some of the charts he saw in our teaching clinic. A note may start, "This 38 year old male..."  and then forever this man remained 38 years old.


 


CMS is making us run scared regarding cloned notes. Again, if things are the same, why would you want to change a few words just to make the note different?


 


Michael Forman, DPM, Cleveland, OH, im4man@aol.com

07/25/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1A



From: Tony Alosco, DPM


 


Do internists treat hypertension, diabetis, and arthritis with medications or just maintain the condition!?


  


Tony Alosco, DPM, Guttenberg, NJ, tonyfoot@netzero.com 


 


Editor's comment: Yes, prescribing medication is treating a condition. There is a significant difference between treating and curing.

07/24/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Ron Freireich, DPM


 


If we see a patient for a mycotic nail care visit and then see them two months later for the same chief complaint, how different can one's progress note be?  Why are we taking something so simple and making it so complicated? 


 


Ron Freireich, DPM  Cleveland, OH, rafdpm@sbcglobal.net


 


Editor's comment: PM News does not provide legal advice. Most insurance companies pay providers to treat conditions, not to maintain them. If a patient presents with mycotic nails every two months and all you do is debride them, the question arises as to the approriateness of treatment. Has the patient been given the option of an oral antifungal? Has the patient been prescribed or dispensed a topical antifungal? Is the condition improving, getting worse, or staying the same? Has the patient been educated on the importance of pedal hygiene or the availability of UV antifungal shoe sanitizers? Any technician could debride mycotic toenails, but as podiatric physicians, we have the responsibility to treat onychomycosis. While a cure is not usually feasible, treatment options are.  

07/23/2014    

CODINGLINE CORNER


Query: Macro Audit Question


 


Our office conducts routine internal audits of our providers' chart notes. Since transitioning to EMR, the doctors have been able to create "macros" for routine nail care treatment. When a patient presents to the office for nail care, most times the diagnosis and treatment are the same. If the doctors' chart notes are almost identical from visit to visit, would that be a problem from an external auditing standpoint? 


 


Kelly Bruce, Kingston, NY


 


Response: The key word is "almost identical." Auditors now use computerized software programs to detect macros; thus identical notes on many charts are likely to trigger an audit. A macro is acceptable to use as a starting point, but should be modified to reflect even small variations that each individual patient exhibits. If not, the implication is that you simply used an old-fashioned rubber stamp to write your chart.


 


Barry Block, DPM, JD, Forest Hills, NY   


 



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07/19/2014    

CODINGLINE CORNER


Query: Home Health Care Questions


 


The home health care agency told us that G0180 could be billed for setting up home health care for dressing changes, physical therapy, and skilled nursing. We would like to know what has to be done to legitimately bill this code? Also, what needs to be documented if, in fact, podiatrists might also bill this code? 


 


Leslie B., Office of Charles Perry, DPM, Cambridge, OH


 


Response: The home health certification codes are certainly a legitimate set of codes and revenue. The forms the home health care agency (HHA) sends you should contain the relevant information needed to care for the patient. Certainly, you should corroborate this information and be sure this is reflected in your progress notes. 


 


G0179 is a Home Health Care Certification for a patient you had previously certified. 


G0180 is a Home Home Health Care Certification for a patient's initial certification. 


Any legitimate diagnosis code which is appropriate to the patient's health issue is appropriate. 


 


Note that if another physician (MD/DO/DPM) has already filed a certification for this patient and period of time, you will not be paid. 


 


Paul Kesselman, DPM, Woodside, NY 


 



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07/16/2014    

CODINGLINE CORNER


Query: Diabetic Shoes - Date of Service?


 


What date of service do I need to use when billing DMERC Region B- Michigan for diabetic shoes? Should I use the day the patient was cast or the day the shoes were dispensed? The paperwork is sent to the patient's physician treating the patient for diabetes (certifying physician). That paperwork is dated for the day we cast the patient for the shoes. Previously, DMERC told me the date on the paperwork to the physician should match the date of service. If I use the dispense date, then it won't match. Which is correct? 


 


Laurie, Billing Office of John Arsen, DPM, Lake Orion, MI


 


Response: All DME, not just diabetic shoes, to all carriers (not just Medicare DME carriers) must be billed on the date the item (in this case the shoes and insoles) are dispensed to the patient. The only other dates you must worry about is that the shoes and insoles are dispensed within 6 months of the time the treating physician's note was written stating the patient needed the diabetic extra depth shoes and insoles. You will also need to document an in-person visit with the patient's doctor to determine the proper shoes and insoles that are best to treat the patient. 


 


There is a check list for therapeutic shoes that comes from CGS (Region C DMAC) that will help you to fulfill all the diabetic shoe requirements. 


 


Paul Kinberg, DPM, Dallas, TX


 



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07/12/2014    

CODINGLINE CORNER


Query: Arthroplasty of Lesser MPJ


 


I have a patient who has damaged cartilage clinically on MRI of the 2nd metatarsal head. She has had exhaustive conservative treatment which has failed. The planned procedure, since she does not have spurring or joint narrowing, is opening the joint, removing damaged cartilage, subchondral drilling and infiltration with platelet rich plasma. Any ideas for coding? 


 


Maureen Crotty, DPM, Tulsa, OK


 


Response: I suggest CPT 28052 (arthrotomy with biopsy; metatarsophalangeal joint). You didn't describe the arthroplasty other than subchondral drilling of the metatarsal head. The drilling of the cartilage would be included in the overall joint procedure allowance. 


 


I suggest you pre-authorize the platelet rich plasma (PRP) injection (billed as 0232T - iInjection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed - or billed as an unlisted procedure, CPT 28899). Note that many payers still consider the use of PRP as investigational. 


 


Tony Poggio, DPM, Alameda, CA  


 



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07/09/2014    

CODINGLINE CORNER


Query: Arthroplasty of Lesser MPJ


 


I have a patient who has damaged cartilage clinically on MRI of the 2nd metatarsal head. She has had exhaustive conservative treatment which has failed. The planned procedure, since she does not have spurring or joint narrowing, is opening the joint, removing damaged cartilage, subchondral drilling and infiltration with platelet rich plasma. Any ideas for coding? 


 


Maureen Crotty, DPM, Tulsa, OK


 


Response: I suggest CPT 28052 (arthrotomy with biopsy; metatarsophalangeal joint). You didn't describe the arthroplasty other than subchondral drilling of the metatarsal head. The drilling of the cartilage would be included in the overall joint procedure allowance. I suggest that you pre-authorize the platelet rich plasma (PRP) injection (billed as 0232T - injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed - or billed as an unlisted procedure, CPT 28899). Note that many payers still consider use of PRP as investigational. 


 


Tony Poggio, DPM, Alameda, CA 


 



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07/08/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Carla-Ruth Poma


 


When coding because of additional time spent with a patient and father, in this case, the use of code 99354 would be appropriate. I agree, in this case, that CPT 99214 is not warranted. More appropriate would probably be CPT 99212 or 99213, depending on notes. Using these codes plus the addition of code CPT 99354 will increase the time allowance; therefore, the payment allowance and the provider will be able to meet the other criteria of the correct E/M procedure code.


 


Carla-Ruth Poma, Owner, Michigan Medical Billing Specialists, Inc., South Lyon, MI

07/07/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Michael G. Warshaw, DPM


 


I have to disagree with the response to this posting. The responder states that if 30 minutes is spent “counseling and coordinating,” etc., then  you could bill for an E/M using the time guideline of counseling and coordinating (involving more than 50%) dominating the visit. CPT 99214 indicates that you spent 25 minutes with the patient and greater than 50% of that time was spent in counseling and coordinating. 99214? Seriously? Using this logic, why not spend 40 minutes with the patient and his father and greater than 50% of the time trying to convince them how important it would be to have the surgery. That would qualify billing a 99215. 


 


The use of time to justify the billing of a higher level of an E/M service is inappropriately utilized...


 


Editor's note: Dr. Warshaw's extended-length letter can be read here

07/05/2014    

CODINGLINE CORNER


Query: Surgical Procedure Not Carried Out


 


I had a 9 year old patient in my office today who was scheduled for a partial nail removal. Everything was set up to perform the procedure, but when it came time to anesthetize the toe, he was not willing to allow me to follow through with the procedure. I did not do a full work-up on this patient, as I had already done this in a previous appointment. I spent 30 minutes trying to convince the patient and his father to allow me to perform the procedure. I was unsuccessful. Can I bill for anything today? 


 


Damian Dieter, DPM, South Bend, IN


 


Response: As is often the case, it's all in the documentation. If your documentation states that you spent 30 minutes "trying to convince them to do it," there's not much there. However, if your documentation states that you spent 30 minutes in "counseling and coordinating", explaining why the procedure is important, educating them as to what could happen if they do not have the procedure done, what the potential risks/benefits were to doing it and not doing it, alternative treatment options, what would be involved in sedation, explaining the option to do it in an operating room, etc...THEN, in my opinion, you could bill for an E/M using the time guideline of counseling and coordinating (involving more than 50%) dominating the visit. CPT 99214 indicates that you spent 25 minutes with the patient and greater than 50% of that time was spent in counseling and coordinating. 


 


Jeffrey Lehrman, DPM, Springfield, PA


 



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07/02/2014    

CODINGLINE CORNER


Query: Weekend Emergency Office Visit


 


An existing patient, who has Medicare, called me Saturday morning on my emergency line, and needed to be treated on Saturday in my office. Is there a special E/M service code for billing Medicare for after hours or weekend emergency encounters? 


 


Donald Triolo, DPM, San Diego, CA


 


Response: The add-on code you're referring to is CPT 99050. That code is defined as "services provided in the office at times other than regularly scheduled office hours or days when the office is normally closed (e.g., holidays, Saturdays or Sundays), in addition to the basic service." However, Medicare has given this code a status code "B" which means that it is bundled into whatever the code(s) are for the basic service(s) you provided. Because it is status code "B", it's not separately reportable to Medicare and it's not separately billable to the patient, even with an ABN. 


 


The bottom line is that you can only bill for whatever treatment you provided. The fact that you had to open your office on a day it's normally closed in order to provide this service is already considered part of the overhead (i.e., is included in a proportional sense in the practice expense RVU for the services you provided). Sorry I don't have better news! 


 


Joan Gilhooly, CPC, CPCO, Lebanon, OH 


 



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06/28/2014    

CODINGLINE CORNER


Query: Psoriatic Heel Icthyosis and Hyperkeratosis


 


I have a traditional fee for service (FFS) Medicare patient who has severe psoriatic dermatitis. Having exhausted topical compounds and all the topical steroids, we even tried special socks - with minimal success. This patient also has painful psoriatic plantar calcaneal spurs, so we've made accommodative orthotics to off-load the heel area as well; again, with minimal success. 


 


His dermatologist has been injecting steroids into his fingers and wrists for years to resolve the dermatological eruptions there. These actually cause the lesions to completely resolve for at least 3-6 months. Certainly, I could attempt to do the same therapy on the skin around his heels. From the coding perspective, what CPT code would be appropriate? Would I code each injection site or simply bill for one injection on the left foot and one for the right? I am assuming I'd also bill for the therapeutic steroid given. 


 


Paul Kesselman, DPM, Woodside, NY


 


Response: Take a look at codes CPT 11900 (injection, intralesional, up to and including 7 lesions) and CPT 11901 (injection, intralesional, more than 7 lesions). 


 


Do these codes describe what you anticipate doing for this patient? If so, then it wouldn't make any difference whether one or both feet are treated. You'd just count up the number of lesions injected and select which of the two codes above is represented by that count. 


 


Joan Gilhooly, CPC, CPCO,Lebanon, OH 


 



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06/25/2014    

CODINGLINE CORNER


Query: Sale of Practice and Billing  New Patient Visits


 


Since I will be retiring in July, and will not be seeing patients, and the new doctor will have a different billing system, can he bill the patients he will see as new patients? 


 


Thomas A. Zoldowski, DPM, Toledo, OH


 


Response: Whether or not the new doctor has a different billing system, the same rules apply. If the patient has been seen by the new physician or another physician of the same group practice within the last 3 years, the patient is considered established to that new doctor. 


 


Joan Gilhooly, CPC, CPCO, Lebanon, OH 


 



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06/21/2014    

CODINGLINE CORNER


Query: Using L4360 vs L4386


 


Our DME vendor is recommending that we switch from using non-pneumatic (L4386) short CAM walkers to pneumatic (L4360) CAM walkers. They are arguing that the level of comfort and compliance is much greater with the pneumatic walker. I know the differential in reimbursement is better; but is this justifiable (i.e., supported by medical necessity)? That is to say, is the vendor's statement (of the superiority and better compliance with pneumatic CAM walkers) actually supported by evidence? Any knowlegeable options would be appreciated. 


 


Danny Albertson, APRN, Office of Paul Krestik, DPM, London, KY


 


Response: You are quite wise in raising your suspicions and questioning whether their statement is supported by medical necessity. Certainly the the level of comfort may be better for some patients, but that is one heck of a broad statement to apply to everyone. Comfort is not a rationale for use, nor does it even come close to justifying medical necessity. Their last statement concerning compliance seems to be 'way out there', as I've seen no studies of any kind showing compliance rates on the use of CAM walking boots vs. other types of immobilization devices. Certainly, I've seen none which compares one type of CAM device to another. And again, even if compliance rates could be proven, that would not be a justification to claim medical necessity. 


 


One of the largest obstacles any physician faces with their patients is getting them to follow instructions. Having patients use a DMEPOS product can be equally as challenging as getting patients to fill and take prescription medication, follow dietary restrictions, exercise regimens, etc. Finally, I think you would agree that your vendor may be more motivated by profit (pneumatic devices have a higher profit margin for the vendor as they do for the supplier), than they are in providing you with the correct advice. Follow your gut feeling, which may include switching vendors. 


 


Paul Kesselman, DPM,Woodside, NY 


 



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06/18/2014    

CODINGLINE CORNER


Query: Provision of Orthotist to Evaluate Patients


 


I was approached by a commercial AFO company which wants to provide me with free professional service by a certified orthotist (CO) or a certified pedorthist (CPed) who will come to my office and evaluate my patients for ankle-foot orthotic therapy. This paid professional will do the patient evaluation, casting of the orthotic device, and will send the cast to the lab who hired them for fabrication. This paid professional will also do the dispensing and fitting/adustment of the device. I am told by the company that I can bill Medicare as the supplier of the device, even though I never actually participated in the treatment. Is this proposal valid and legal? 


 


Name Withheld by Moderator


 


Response: I have some very real concerns. From a business management point of view, this arrangement places an orthotist in your office, presumably to make independent judgments, based upon your in-office "referral." But the arrangement sounds anything but independent, and it's all done on your signature and reputation. The orthotist is selected and "owned" by the commercial company. The patients' understandable presumption is that this is someone who you know and trust. In addition, they offer you the opportunity to bill as the "supplier", and I'm not so sure that this arrangement meets that legal definition. 


 


I am not an attorney, but I see lots of red flags here. I  see lots of major legal issues which could come back and haunt you - but not the commercial supplier. You have a lot to lose; they don't. Be particularly aware of Federal Stark laws. If the government is "unhappy," they will come after you - not the commercial entity. This arrangement makes me very nervous. As a minimum, get your own healthcare attorney to independently review everything. Make sure it is an attorney who understands healthcare law and contracts. 


 


Rick Horsman, DPM, Olympia, WA  


 



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06/14/2014    

CODINGLINE CORNER


Query: Accountable Care Organizations


 


Has anyone had any experience with the new ACOs? Our clinic has two podiatrists that are part of a new ACO, and they are wondering if there are any suggestions on how to keep costs down. They are looking for a matrix for podiatry that has been successful. 


 


Lani Smith. Office of Kash Siepert, DPM, Roseburg Foot & Ankle


 


Response: The best way for an ACO to keep foot healthcare costs down is to prevent foot problems from happening in the first place -- such as complications from diabetic peripheral neuropathy. In Las Vegas, we are presenting ACOs and medical homes with an organized program of preventive foot care. I would be happy to talk to your podiatrists about this and other cost-containment actions and policies that ACOs like. They can email me at lrubin@leapalliance.org


 


Lawrence Rubin, DPM, Las Vegas, NV 


 



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06/11/2014    

CODINGLINE CORNER


Query: Billing for EMS Visit


 


A patient came to my office, and had chest pains in the waiting room. I called 911, took him into a treatment room, had him lie on the treatment chair, and monitored his vital signs. I stayed in attendance the full time until EMS came, and gave information to EMS. He was then transported via EMS to the hospital. 


 


Can I bill for this encounter? If that is the case (and it seems to me that it should be), what is the applicable diagnosis and CPT coding? 


 


Ron Werter, DPM, NY, NY


 


Response: You have the choice to consider it a Good Samaritan action, or to bill for it. Since it happened in your office (rather than in a restaurant, or an elevator, or something like that), it truly is your choice. 


 


If you do decide to bill for it, you'd just bill the appropriate regular office visit code (99201-99215) based either on the amount of history, exam, and MDM you did, or on time, if more than 50% of the face-to-face time you spent with the patient was in counseling and coordination of care. I suspect that EMS arrived before you met the applicable threshold for billing the prolonged services code for the office setting. Even critical care requires a minimum of 30 minutes -- but from what you've described above, because you weren't needing to do or order any interventions to prevent life-threatening deterioration in the patient's condition, those codes wouldn't be appropriate either. It's going to be just a regular OV code. 


 


Your primary ICD-9 code is going to be 786.50 (chest pain, unspecified) or 786.59 (chest pain, other), the latter of which includes chest pain that is more like discomfort, pressure and/or tightness. If the patient had any other symptoms such as SOB (786.05) diaphoresis (780.8), or pain in his arm (729.5), you should include those as secondary diagnoses. 


 


Because you're a podiatrist, don't be surprised if the insurance carrier denies it as being performed for a reason that is outside of your scope of practice. At that point, just appeal with the documentation that clearly describes the HPI, ROS, PFSH, and exam information you gathered (including the serial vitals) and describes the scenario up until EMS left your office. If you did any interventions such as give the patient an aspirin or administer oxygen until EMS arrived, be sure your documentation includes that information, as well. 


 


Joan Gilhooly, CPC, CPCO, Lebanon, OH 


 



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06/11/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Jeffrey Kass, DPM


 


Last year, at the House of Delegates in New York, E Advocacy was being discussed. While, we were being told about the importance of utilizing this feature, I attempted on my iPad to send off letters to my local Congress people. I was unable to. It turns out that the APMA site was unable to work with mobile devices. I brought this up to Drs. Gastwirth and Spinosa at the House. I have not since attempted (to use the system from my iPad), but hopefully this was corrected. 


 


A second reason why I think the function is underutilized is because it takes effort. PM News comes into our email, we open it and read it. While APMA does send blast emails, after opening them, one has to log in. I think people, in general, are lazy, and this extra step is where we get caught up on the underutilization. Laziness and not wanting to take the extra step are only hurting ourselves and should not be an excuse. 


 


Jeffrey Kass, DPM, Forest Hills, NY, jeffckass@aol.com

06/07/2014    

CODINGLINE CORNER


Query: Partial Rupture of Ligament


 


I am trying to bill a pneumatic walking boot given to a patient for a partial rupture of the plantar fascia. Does anyone know what the ICD-9 code is for the partial rupture of the plantar fascia? I can find a rupture of a tendon, but not a rupture of the ligament. 


 


Jan Tepper, DPM, Upland, CA  


 


Response: I recommend ICD-9 845.19 (sprains and strains of ankle and foot, other). There is no specific code that describes a partial or complete rupture of the plantar fascia. 


 


Robert Weatherford, CPC, Jacksonville, FL


 



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06/05/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From:  Al Musella, DPM


Dr. Kinberg said: "You are correct in realizing this is a federal CMS rule. To change the statutory requirements and language, you would need to speak to your congresspersons and senators. And good luck with that. "



I run a cancer organization, and we have had some success with changing CMS rules. We helped get major changes in coverage a few times and haven't failed yet, although we are in a big battle now that looks tough. The key is to get patients involved. CMS doesn't care about making the doctors or the drug companies happy. They do care about the patients. I have seen a few cases where doctors and drug companies requested changes and got nowhere until the patient groups got involved.



A change such as allowing NPs to complete the paperwork instead of MDs would save CMS money - or at least not cost anything - and that should be an easy change. And Dr. Kinberg is incorrect in the process. To get such a change, the fastest way is to go through the correct process. Any individual can start the process, but it would be best if it came from the APMA and the NP association. There would then be an open public comment period. This is the time to get the patients involved. The patients would submit comments, and also ask their congresspeople and senators to get involved.



Perhaps it is time to set up a database of patients who are willing to write letters and make phone calls to help make Medicare coverage for podiatry better for the patients. APMA  could set up such a database and ask APMA members to post flyers in their waiting rooms asking patients to participate. Even if each podiatrist only had one patient sign up, we would be a force to reckon with. If it works, then we can try something big like clear up the mycotic nail and routine foot care situation. 



Al Musella, DPM, Hewlett, NY, musella@aol.com


06/04/2014    

CODINGLINE CORNER


Query: NPs and Diabetic Shoe Paperwork


 


It is time to get the LCDs changed. I understand that my region's LCD states that the CMN (certificate of medical necessity) and attestation form or diabetic foot exam must be signed off by an MD or DO. But I also understand that there are 19 states that allow COMPLETE autonomous, independent practice authority for NPs. In my state, there are many independent NP practices, and it is a true problem. I am in discussions with my legislators regarding this issue, but would appreciate any advice on how to get this archaic rule changed. It seems like an issue that the APMA should be involved with. Thoughts? 


 


Daniel Albertson, APRN, Office of Paul Krestik, DPM, London, KY


 


Response: You are correct in realizing this is a federal CMS rule. To change the statutory requirements and language, you would need to speak to your congresspersons and senators. And good luck with that. 


 


APMA has been involved in the attempt to revise statutory language not to increase the program, but to try to make it more efficient and thus more effective. APMA has discussed the issues with the DME medical directors as well as CMS without resolution. AMA has also discussed this issue, again, without resolution. You should be aware that APMA has tried the legislative approach to improving the efficiency of the therapeutic shoe program, but given the toxic legislative time we live in, the solution has not had a chance to be presented in Congress. 


 


Paul Kinberg, DPM, Dallas, TX


 



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05/31/2014    

CODINGLINE CORNER


Query: Coding for Ankle Joint Arthroplasty


 


How do I code the procedures all done on the left foot/ankle?: 


 


- Excision of an exostosis located across the dorsal aspect of the talar neck; 


- Removal of ossicle, anterior aspect of the ankle; and 


- Excision of exostosis, anterior distal fibula 


 


Robert Steinberg, DPM , Schaumburg, IL


 


Response: These procedures that were performed are all related to peri-articular structures of the ankle joint. I recommend one code, CPT 27700, arthroplasty, ankle joint as the best coding that would be inclusive of all three procedures that were done. I don't think it would be reasonable to unbundle these into three separate codes for each anatomical location. 


 


Howard Zlotoff, DPM, Camp Hill, PA 


 



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05/28/2014    

CODINGLINE CORNER


Query: Coding Maggot Therapy for Ulcers


 


One of the physicians in our office is considering the use of maggot therapy to treat a chronic ankle venous stasis ulcer. Does anyone have experience or any knowledge about the CPT coding for maggot therapy of an ulcer? Any suggestions for the coding for the supplies? The patient is covered by Medicare. 


 


Nancy, Biller, Office of Matthew Lappenga, DPM, Holland, MI 


 


Response: I have used maggot therapy for years..there is no CPT code. The patient pays. I reserve maggot therapy as a last gasp measure prior to amputation for ischemic ulcers that are non-bypassable. Most of the time, patients have no qualms about paying for it. 


 


By the way, I don't believe you'll find it indicated for venous stasis ulcers, though. If you use it for this type of wound, be prepared to prescribe a narcotic for a few days. Keep in mind that it is all about compression for venous ulcers. 


 


Bruce Kaczander, DPM, Southfield, MI 


 



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05/24/2014    

CODINGLINE CORNER


Query: Plantar Plate Repair Coding


 


I have a patient with a plantar plate tear that requires surgical repair. What are the correct ICD-9 and surgical codes for this procedure? 


 


Farshid Nejad, DPM, Los Angeles, CA


 


Response: There have been multiple suggestions for CPT codes of procedures that would be similar or something like what is done in the repair of a digital plantar plate (think ligament). In reality, you do not code by "similar to" or "approximately like". 


 


The most accurate code is the unlisted foot/toe code, CPT 28899. 


 


Harry Goldsmith, DPM, Cerritos, CA 


 



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