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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:


10/24/2017    

CODINGLINE CORNER



Query: Code S90.322A Rejected by Payers


 


The APMA Coding Resource Center has S90.32- listed with a 7+. Why is Capital Blue Cross and Aetna rejecting S90.322A for contusion of left foot, initial encounter?


 


Edwin S. Hart, DPM, Bethlehem, PA


 


Response: The contusion code is listed in the APMA Coding Resource Center as S90.3- (Quick Index) with the ICD-10 Shortcut noting S90.32x-  with a 7th character indicator (the “x” is a placeholder and remains as an “x” in the valid seven character code). It is also listed as S90.32- in the Tabular List with a 7th character indicator. You would add the “x” character in the 6th position, then choose the appropriate 7th character to complete the valid code.


 


If an ICD-10 code is listed in the Tabular Listing with only 5 characters, like this one, and there is a notation that a 7th character is required, you need an “x” placeholder in the 6th position to expand the code as you choose the appropriate 7th character. The correct valid code for left foot contusion, initial encounter would therefore be S92.32xA (S92.32XA, the lower character “x” vs. use of the capitalized “X” is your choice).


 


The same concept applies if a code in the Tabular Index is 4 characters long and there is an indicator noting a requirement of a 7th character. In that situation, you would need an “x” in the 5th and 6th positions, then choose the appropriate 7th character.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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10/21/2017    

CODINGLINE CORNER



Query: Coding Diabetic Ulcers Along With Circulation Issues


 


In the ICD-10 coding webinars, the coding was listed with the atherosclerosis I70- series code first, then the ulcer code, L97-, followed by diabetes mellitus with foot ulcer, E11.621. Would it be appropriate to code E11.621 first, then the specific L97- code followed by E11.51 or E11.52 for diabetes mellitus with circulatory complications to cover the peripheral vascular disease?


 


Mary Gail Kwiecinski, DPM, Libertyville, IL


 


Response: The ICD-10 instructions for E11.621 say, “Use additional code to identify site of ulcer (L97.4-, L97.5-).”   Therefore, your scenario of coding is correct; you would bill:


 


E11.621


L97- (requires additional characters for specificity)


E11.51 (or E11.52) 


 


in that order on the claim.


 


Paul Kinberg, DPM, Dallas, TX



 


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10/17/2017    

CODINGLINE CORNER



Query: Diagnostic Block of the Ankle Joint


 


How would you code a diagnostic ankle block into the ankle joint?


 


Michele Kurlanski, DPM, Scarborough, ME


 


Response: I suggest coding CPT 64450 (injection, anesthetic agent; other peripheral nerve or branch).


 


I have been hearing about denials on this from podiatrists around the country. I suggest you check on coverage for this before using it.


 


If this is a Medicare patient, check your LCD and if a private payer, see if they have a policy for peripheral nerve blocks. If this is a non-Medicare payer, you can also attempt to get a pre-authorization.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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10/13/2017    

CODINGLINE CORNER



Query: Medicare Claims Data Rates


 


A consultant looked at our Medicare claims data and said our collection rate is in the mid 80s for collection of Medicare allowable when it should be 93%. Can anyone tell me if this figure of 93% is what the average practice collects, or what else it may represent?


 


Jennifer, Office of Charles Perry, DPM, Cambridge, OH


 


Response: There is no magic number when it comes to a collection rate or ratio. The variables are immense when looking at these kinds of ratios. For instance, you may have a high percentage of Medicare-Medicaid patients, or you may have a very high number of patients without a secondary or supplemental insurance coverage secondary to Medicare. That will definitely lower the collection rate. It will also vary depending on the specialty, as some specialties render a higher number of “not medically necessary” services (those services that are truly necessary for the care of the patient but Medicare considers them to fall within the medically unnecessary). Is your consultant correct, though, that your collection ratio of Medicare allowable is too low?  It’s very possible.


 


Perhaps your consultant identified that your staff is not collecting the way they should at the time of service. Perhaps, they noted that your staff is not using the Medicare ABN properly and collecting (again – at the time of service). Perhaps, you are not accepting credit cards for the deductible or giving your patients the option of writing their credit card number on the statement you send them. There are too many facets of good medical collections for anyone to be able to say you should or should not have a 93% allowable collection rate based on your question. I’ve seen some with a collection ratio in the upper 90 percentile and some doing a fantastic job in getting an 80% ratio due to their location, demographics, local economic condition, insurance mix, etc…and I’ve been teaching this since the mid-80s.


 


Don Self, Whitehouse, TX



 


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10/10/2017    

CODINGLINE CORNER



Query: Billing CPT 28285 & CPT 28234 Together


 


How should codes CPT 28285 (correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) and CPT 28234 (tenotomy, open, extensor, foot or toe, each tendon) be billed out to get payment for both codes? We billed both codes and were paid for CPT 28285 only. CPT 28234 was denied stating it was part of the primary procedure. There were 2 separate incisions made, one for each code.


 


Lawrence Lloyd, DPM, Anderson, IN


 


Response: Technically, you should be paid for both if done through separate incisions and documented as such. Most payers, however, will bundle these code bundles automatically. CPT 28285 should be the primary code and CPT 28234 the secondary code (billed with a “59” modifier).


 


I would appeal, include the operative note documenting the separate incision approach. The CCI (Correct Coding Initiative) allows for the two codes to be billed together and modified as noted above when appropriate.


 


Mike King, DPM, Roswell, GA



 


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10/06/2017    

CODINGLINE CORNER



Query: 1st MTPJ Arthroscopy


 


What code would be best for the arthroscopy of 1st metatarsal-phalangeal joint? Is there a code or do I bill CPT 29999 (unlisted procedure, arthroscopy)?


 


Michael Downey, DPM, Fort Worth, TX


 


Response: There is no specific code for 1st metatarsal-phalangeal joint arthroscopy. Your only option is CPT 29999 (unlisted procedure, arthroscopy). Whenever you submit an unlisted code, it is strongly recommended you receive pre-op authorization from the payer. In your letter of explanation, make sure you compare your unlisted code to the regular CPT code with what you believe to be a similar RVU procedure (e.g., CPT 29905 [subtalar joint arthroscopy – surgical; with synovectomy; facility RVU: 19.9]).


 


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


 



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10/04/2017    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Lawrence Burns, DPM


 


I suggest code CPT 15004 (prep of wound for graft), then CPT 15275 (application, if preformed in OR).


 


Lawrence Burns, DPM, Nashville, TN

10/03/2017    

CODINGLINE CORNER



Query: Home Visits & Assisted Living Facility E/M Code Documentation Requirements


 


I was hoping to find E/M code documentation requirements for home visits and assisted living facilities. I know the CPT codes range from CPT 99324-99350 and guidelines for coding/billing, but it is hard to come by documentation requirements.


 


Marc Colaluce, DPM, St. Petersburg, FL


 


Response: Like any other visit, the medical record must document the medical necessity and not the convenience of the visit for the patient. NGS has stated the following in their guidelines for home visits: “Home visits are not covered when provided simply for the convenience of the patient. For example, an elderly, frail patient may not be able to travel to a physician office in February with ice and snow on the ground and below freezing temperatures, but may easily do so in May or June. Patients who are able to go to offices/hospitals for tests or elsewhere for recreational activities might be expected to do the same for their physician visits.


 


If the necessity of the home visits is not clearly indicated, these visits will be re-coded to the Office or Other Outpatient Services Established Evaluation and Management Service code (CPT 99211-99215) at a level supported by the documentation.”


 


Mike King, DPM, Roswell, GA



 


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09/30/2017    

CODINGLINE CORNER



Query: Debridement v. Stem Cell Skin Substitutes


 


In application of a stem cell substitute, such as Grafix, debridement in preparing the wound bed is included in the description. If one both debrides and applies a stem cell graft, the payment for CPT 15275 is about $100, while at least in Florida, a debridement through fascia alone as an outpatient procedure pays about $160 for a CPT 11043 (less than 20 sq cm). This makes no sense to me, so I assume I am interpreting the use of the codes incorrectly. Clearly the CPT 15275 could not include the work of CPT 11043. If it did include both, shouldn’t one expect the RVUs and reimbursement to reflect the value of both the debridement and application?


 


Does one code the debridement CPT 11043 (or other depth as appropriate), and consider the Grafix as an “implant” and not bill it, much like one would not bill for insertion of a screw with an osteotomy? Or should one only bill CPT 15275? Is the debridement as preparation only for a more granular wound that doesn’t need separate excisional debridement in which case one would bill CPT 11043 and CPT 15275 if there is considerable depth involved?


 


Stephen Lasday, DPM, Bradenton, FL


 


Response: You’ve made the assumption that the debridement and Grafix application are performed on the same date of service. The skin substitute guidelines in CPT and some MAC LCDs note that the debridement should be minimal at the time of application of the skin substitute/stem cell allografts; that is, the wound should have minimal need for further debridement at the time of application. I suggest that you schedule the patient for their last debridement a few days prior to the application of the allograft. 


 


Paul Kesselman, DPM, Woodside, NY



 


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09/26/2017    

CODINGLINE CORNER



Query: Osteoporosis Testing and Fracture Care


 


I have a patient who was diagnosed by x-ray studies to have a 2nd metatarsal fracture, right foot. There was no history of known trauma related to the injury. I immobilized the patient. I billed for the fracture care (CPT 28470 – closed treatment of metatarsal fracture; without manipulation, each). During a 6 week follow-up, the fracture showed poor signs of healing. The patient was questioned further and was found to be a post-menopausal female who had not previously undergone osteoporosis screening with a DEXA scan.  


 


According to national guidelines, any post-menopausal woman who suffers a fracture and has not had a DEXA scan in the past two years should be sent for further studies. This was ordered at her follow-up visit during the fracture care global period. Would using a secondary diagnosis of osteoporosis (M81.0 localized osteoporosis) and billing an office visit during the global period be appropriate even if you plan on referring the patient back to their primary care doctor for further care if the DEXA scan findings are positive?


 


Pamela Gekas, DPM, Woodbury, NJ


 


Response: I assume the original diagnosis was a pathological fracture. The question is: was the osteoporosis present pre-op? Or was there a noticeable presence of osteopenia signifying a change in the bone density 6 weeks post? I assume you are making the osteopenia diagnosis from her history and x-ray confirmation. While the patient denies trauma or injury, there is still the possibility a minor injury that she doesn’t remember resulted in a fracture. While she may not have fallen, she may have started an exercise program (jogging, long walks, etc.), she may have gained weight, or has a job where she is on her feet more.


 


As a foot and ankle specialist making a diagnosis from a clinical exam and x-rays, and then ordering a DEXA scan, it may be considered a screening exam, especially with your diagnosis explaining her fracture. The question is: why are you ordering the DEXA scan, especially if you will be referring? So document well your rationale beyond her age, or the test could get denied. If you are going to refer the patient back for treatment and schedule future DEXA scans, if necessary, I would not be attempting to bill an E/M service during the global surgical period. I feel that the finding of osteopenia and connecting it to the delayed healing links the two. Any E/M related to the surgery in a post-op period is included in the surgical allowance. You would not use a “24′ modifier to qualify the E/M.



 


Tony Poggio, DPM, Alameda, CA


 


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09/23/2017    

CODINGLINE CORNER


Query: Fracture Care *-24* Modifier


 


A patient was seen for a right distal fibular fracture. A diagnosis code of S82.64XA (nondisplaced fracture of lateral malleolus of right fibula; initial active management) was billed with office visit and fracture care codes: CPT 99203, CPT 27786  (closed treatment of distal fibular fracture (lateral malleolus); without manipulation)


 


The patient was seen for follow-up care at 6 weeks, at which time the fracture was noted to be healed. The patient was asymptomatic at the fracture site, although there was still pain and laxity to the lateral collateral ligaments. At that time, I placed the patient in an ankle brace and prescribed physical therapy. Would it be appropriate to bill an office visit with a “-24” modifier during the fracture care global period using a secondary diagnosis of an ankle sprain S93.491A?


 


Name Withheld by Moderator


 


Response: CPT 27786 as a 90-day global period. As such, anything you do for the fracture and its related components (your scenario did not note how the patient sprained the tendon; we don’t know if it was a separate injury) would be, I feel, part of the fracture complex of symptoms and findings. In my opinion, the care described is part of the global surgical episode. The E/M with a “24” modifier cannot be separately billed.


 


Paul Kinberg, DPM, Dallas, TX


 


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09/19/2017    

CODINGLINE CORNER



Query: Excision of 2 Neuromas 1 Foot


 


I am trying to find out the correct way to bill Medicare for the removal of 2 neuromas on the same day, same foot (right). Do I enter one line with CPT 28080 at 2 units, or 2 lines using the “XS” modifier on the second CPT 28080?


 


PM News Subscriber


 


Response: I recommend that you bill 2 separate lines and append CPT 28080 on the second line with either the “X” modifier or the “-59” modifier. The “X” modifiers are valid, but it is unclear to me how many payers actually process that modifier. It was presented several years ago, but then never really mandated. Personally, I would stick with the “-59” modifier.



 


Tony Poggio, DPM, Alameda, CA


 


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09/16/2017    

CODINGLINE CORNER



Query: Medicare Payments for L3000


 


In recent months, we have had two Medicare patients ask us to bill their L3000 devices to Medicare for consideration. We told the patients that these are non-covered items and had them sign ABNs. We also collected our fees for the L3000s. To our surprise, Noridian, our DME Medicare contractor, paid for the devices for both patients…and those patients are rightfully demanding refunds. Has Medicare policy changed regarding coverage for L3000? Are they now covered items? Can anyone please clarify. We are in Southern California.


 


PM News Subscriber


 


Response: Suffice it to say, I feel the DMAC messed up and paid claims they should not have paid. Custom foot orthotics (L3000) are only covered for Medicare patients when those are part of a leg brace permanently attached to a shoe. In those instances, the “KX” modifier should be appended to the HCPCS code(s) to obtain the appropriate coverage.


 


In your case (and you did not say if you did), I would have recommended you append a “GY” (statutorily non-covered) modifier to the HCPCS code(s). This modifier should prevent any confusion in the future, properly denying those claims. For the two claims you said did pay, I urge you to immediately voluntarily refund back to Medicare the monies you received. Your MAC may have a special form for you to use; please use it if appropriate. You should also attach the original EOBM for each claim you are refunding.


 


Paul Kinberg, DPM, Dallas, TX



 


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09/13/2017    

CODINGLINE CORNER



Query: Foreign Body Coding


 


I have a patient who came to my office complaining of pain in her right heel that has been present for about one week. X-rays revealed what looks like a needle deep in the heel fat padding near the calcaneus. I am looking for an ICD-10 code for a deep foreign body, right heel, but all I find is a puncture code. 


 


Codingline Question


 


Response: In my opinion, the appropriate diagnosis code would be S90.851A Superficial foreign body, right foot; initial encounter


 


Follow-up encounters would be coded S90.851D (“D” for subsequent visits).


 


Donald R Blum, DPM, JD, Dallas, TX



 


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09/09/2017    

CODINGLINE CORNER



Query: Split Reporting for MIPS


 


Our office recently signed up for the APMA Registry for reporting MIPS. I realize some measures are only available on a registry system, while others are available on claims and registry. Does it make sense, or is it possible to report both ways, registry and claims?


 


When PQRS was in effect, we reported via registry and it was a much more efficient way to capture the needed information.


 


Lisa Karpelman–Practice Administrator, Office of Herbert Karpelman, DPM, Cheshire, CT


 


Response: Not in 2017. In 2017, all Quality measures must be reported by the same mechanism. Most podiatrists are reporting their Quality measures via either claims or registry. There are some other options.


 


In the 2018 QPP Proposed Rule, this requirement is changed to allow reporting of different Quality measures by different mechanisms, but there is no change for 2017.


 


Jeffrey D Lehrman, DPM, APMA MACRA Task Force, Springfield, PA



 


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09/07/2017    

CODINGLINE CORNER



Query: Amniofix Injection


 


While we make our patients pay privately for the AmnioFix injection, can we still bill the insurance company for an E/M visit the same day? What about dispensing a CAM walking boot? Or should that be part of the fee associated with the AmnioFix?


 


Amy Meehan, Billing Manager, Potomac, MD


 


Response: Addressing the E/M question, I suggest billing for an E/M service at the time of the injection only if an E/M was performed and documented that was separately identifiable from the procedure. If the injection was a scheduled procedure, and was already discussed and planned at a previous visit with the patient coming in just to get the injection done, I do not suggest coding an E/M for the visit; just the injection. On the other hand, if it is their first visit for this problem, and the complaint is worked up, diagnosed, treatment options discussed, and a decision is made all prior to the injection, I think it is appropriate to code an E/M for that part of the visit.


 


Regarding the CAM walking boot, for most carriers, CAM boots are covered for immobilization for a musculoskeletal condition or following surgery. They are not covered if they are being dispensed to off-load a plantar foot ulcer. Be careful with what you are dispensing CAM boots for.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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09/05/2017    

CODINGLINE CORNER



Query: Billing for Removal of Gouty Tophi


 


My patient underwent removal of gouty tophus in the 1st interphalangeal joint of his left hallux. I was wondering, because it is not infected and not an abscess, if the removal of tophus would be coded as CPT 28024 (arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint).  If not, what code would be best?


 


Nicholas Pagano, DPM, Plymouth Meeting, PA


 


Response: I agree that CPT 28024 (arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint) is the best option for the procedure described here to remove intra-capsular tophi.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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09/02/2017    

CODINGLINE CORNER



Query: Qualified Routine Foot Care for CMT Patient


 


I have a 26 year old male patient with peripheral neuropathy due to Charcot-Marie-Tooth disease. Can someone suggest appropriate “asterisked” ICD-10 code to bill to qualify routine foot care for this patient? The patient is disabled and has Medicare coverage.


 


Boris Raginsky, DPM, E. Brunswick, NJ


 


Response: You need look no further than G60.0 (hereditary motor and sensory neuropathy) which includes Charcot-Marie-Tooth (CMT) disease. This code is not marked with an asterisk (*) in the LCD, meaning the patient does not need to be under the active management of a physician for that disease. However, all the other requirements for “covered” foot care still apply for the patient to have coverage. The patient would need class findings qualifying “Q” modifier use.


 


The problem is that “Q” class finding modifiers are vascular findings. I would not try to “force” a diagnosis code to obtain coverage since a 26-year-old with CMT disease probably does not have the severe vascular compromise needed for “Q” coverage.  Additionally, you would not be able to use the LOPS (Loss of Protective Sensation) codes, G0245, G0246, G0247, since their guidelines state that these codes are to be used only for patients with diabetic peripheral neuropathy. Unfortunately, your patient may not qualify for coverage and would be a cash-paying patient.


 


Paul Kinberg, DPM, Dallas, TX



 


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08/29/2017    

CODINGLINE CORNER



Query: Confirming Diagnosis of Met Fracture


 


I had a patient come in with a diagnosis of closed non-displaced fracture of the 5th metatarsal left foot. The patient had seen 2 orthopedic surgeons prior to coming to see me for another opinion. Previously, she had x-rays taken, and treatment was initiated. I reviewed the x-rays, examined her, and confirmed the diagnosis, agreeing with the current treatment. What would be the diagnosis code? For the 7th character in the diagnosis, do I put an “A” (for the initial visit) or a “D” (for subsequent visit since she had seen 2 orthopods and treatment had been initiated)?


 


Codingline Archive Question


 


Response: Since the diagnosis had already been made and since you concurred with the previously initiated and ongoing treatment, “D” is the appropriate 7th character in this case. I am glad that you specified the fracture and its being non-displaced and closed. Remember, ICD-10 rules that state a fracture which is not specified as displaced or non-displaced must be coded as displaced. A fracture that is not specified as open or closed is coded as closed.


 


Your ICD-10 code would be S92.355D


 


Paul Kinberg, DPM, Dallas, TX



 


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08/25/2017    

CODINGLINE CORNER



Query: Follow-Up E/M After Lab Tests


 


I have a patient I sent for an HbA1c. In a week, I got the report in the mail. She had moderate blood sugar control. I scheduled the patient to come in the office to review the lab report during which the patient had a lot of questions. We discussed possible diet modifications and exercise options. The visit took ten minutes. Can I bill a time-based E/M code (e.g., CPT 99211) for the encounter?


 


Guy Del Prince, DPM, Ashtabula, OH


 


Response: Yes, you absolutely can bill this encounter based upon time. I suggest CPT 99212 as that code description states 10 minutes of face-to-face time with the patient/family. CPT 99211 is a visit that does not necessarily even require the presence of the doctor and typically takes five minutes of face-to-face time – which you exceeded.


 


Document the time spent and what was reviewed to justify this billing code. Bill for what you did. Undercoding to a CPT 99211 is unnecessary and costs you money.



 


Tony Poggio, DPM, Alameda, CA


 


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08/22/2017    

CODINGLINE CORNER



Query: Decubitus Ulcer Coding with CPT 97597


 


We are having rejection from Medicare when submitting CPT 97597 (selective debridement) along with L89.623 (pressure ulcer of left heel, stage 3). Are we to use a 7th character at the end representing initial, subsequent, etc.?


 


Edwin S. Hart, DPM, Bethlehem, PA


 


Response: L89.623 (pressure ulcer of left heel, stage 3) is a complete code and does not require a 7th character. A stage 3 pressure ulcer is “full thickness skin loss involving damage or necrosis of subcutaneous tissue, left heel“. If this is what your patient has and you only did selective (superficial) debridement, I believe L89.623 and CPT 97597 would be the appropriate codes.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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08/19/2017    

CODINGLINE CORNER



Query: Roll-A-Bout Knee Scooter Rental


 


Is our practice allowed to rent out a Roll-A-Bout Knee Walker (scooter) to our patients if those scooters aren’t directly purchased by the practice? For example, if a patient drops off a used scooter (they don’t need it anymore), can I rent it out or sell that to my patients at a discount?


 


Name Withheld by Moderator


 


Response: Renting out equipment is a ‘slippery slope’. There are rules about renting and even loaning (for free) durable medical equipment. There is liability if the patient injures his/herself because of defect or improper instruction. You most likely need a technician (certified) to inspect the device and certify that it is in working order (again, even if it is loaned out at no cost), and you need to make sure the patient is instructed properly in the use of this device.


 


Your medical malpractice insurance might not insure you or your practice on the rental of the device, so check with your liability insurance company. Most doctors who rent out equipment do it as a separate company, but remember there could be Stark rules or state laws to follow.  


 


Donald R Blum, DPM, JD  Dallas, TX



 


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08/15/2017    

CODINGLINE CORNER



Query: Decubitus Ulcer Coding with CPT 97597


 


We are having rejections from Medicare when submitting CPT 97597 (selective debridement) along with L89.623 (pressure ulcer of left heel, stage 3). Are we to use a 7th character at the end representing initial, subsequent, etc.?


 


Edwin S. Hart, DPM, Bethlehem, PA


 


Response: L89.623 (pressure ulcer of left heel, stage 3) is a complete code and does not require a 7th character. A stage 3 pressure ulcer is “full thickness skin loss involving damage or necrosis of subcutaneous tissue, left heel“. If this is what your patient has and you only did selective (superficial) debridement, I believe L89.623 and CPT 97597 would be the appropriate codes.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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08/12/2017    

CODINGLINE CORNER



Query: Medicare Billing for X-Rays


 


We have a CR digital x-ray system. The new ones are DR. It is my understanding that Medicare is going to be cutting x-ray reimbursement by 2-10% for non-DR x-rays. I also understand there is an “FX” modifier. What is the correct way for us to bill given we have a CR digital system? Do we use the “FX” modifier?


 


Office of Mark M. Goldberg, DPM, Chestertown, MD


 


Response: CR-based x-rays are scheduled to be reduced by 7% beginning next year and then reduced by 10% beginning 2023. As of now, I do not believe that the “FX” modifier applies to CR-based x-rays. I suspect that a new modifier would be available for CR-based x-rays effective 2018.


 


Paul W Kim, JD, MPH, Baltimore, MD



 


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08/08/2017    

CODINGLINE CORNER



Query: Core Needle Biopsy of 4th Metatarsal


 


My patient has a tumor/lesion on the 4th metatarsal, with possibility of a giant cell tumor or enchondroma. I discussed the case with an ortho-oncologist, and he recommended a core needle biopsy. The problem is that I cannot find the appropriate code for a bone biopsy. Can I use partial excision of bone code (CPT 28122 – partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; tarsal or metatarsal bone, except talus or calcaneus) or an arthrotomy of tarsal-metatarsal joint code (CPT 28050 – arthrotomy with biopsy; intertarsal or tarsometatarsal joint)?


 


Michael Downey, DPM, Fort Worth, TX


 


Response: I am picturing this biopsy as a stab incision over the 4th metatarsal and the core needle going into the 4th metatarsal. If that is the case, the only code I suggest you consider is CPT 20220 – biopsy, bone, trocar, or needle; superficial (e.g., ilium, sternum, spinous process, ribs).


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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ASPMA