Spacer
NeurogenxAS217
Spacer
PresentBannerCU117R
Spacer
INGBannerE215
Podiatry Management Online


Facebook

Podiatry Management Online
Podiatry Management Online


NeurogenxGY217

Search

 
Search Results Details
Back To List Of Search Results

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


Codingline subscription information can be found at:

http://www.codingline.com/subscribe.htm


Other messages in this thread:


02/24/2017    

CODINGLINE CORNER


Query: Medicare ABN


 


Is there appropriate terminology or a “good” reason to use the Medicare Advance Beneficiary Notice (ABN) form for why Medicare may not pay for an AFO, therapeutic (diabetic) shoes, etc., other than “not covered item, does not meet Medicare criteria, could be fit with a pre-fab device, etc” to cover us, so that if the claim is denied, we can collect from the patient?


 


Gary Friedlander, DPM, Glendale, AZ


 


Response: The reason for the Advance Beneficiary Notice (ABN) and the need for stating probable denial is to inform the patient prior to treatment (or dispensing) that they may be responsible for payment.


 


I always include frequency of service as a possible reason for denial. The reasons you included are correct as well. If you choose possible denial because “not covered item, does not meet Medicare criteria” and Medicare indicates “patient did not meet the criteria due to frequency of service”, you can still bill the patient as long as you have the signed ABN on file and include the ABN modifier (“GA”) on the claim.


 


Donald R Blum, DPM, JD, Dallas, TX


 


For information on Codingline subscriptions, click here

02/21/2017    

CODINGLINE CORNER


Query: Wound Biologics Wasted Product


 


My representative for Epifix says we now have to document the ‘waste’ of the product not used/applied to the product supply code (e.g., Q4131-JW). How is that ‘waste’ measured (i.e., a circular product measures 2.4 cm in diameter and the ulcer measures 1.0cm X 0.5cm)?


 


Gary Friedlander, DPM, Phoenix, AZ


 


Response: I suggest you document how many square centimeters of product were applied to the ulcer and how many square centimeters were wasted. Your product is a circle with a diameter of 2.4 cm. Its radius is 1.2 cm. The area of a circle is pi X radius squared. 1.2 cm squared is 1.44 cm. So now we multiple 1.44 cm by pi and get 4.5 sq. cm. Your product is 4.5 sq. cm. Your wound has an area of 0.5 sq. cm.


 


If you only cover the wound with no overlap, I suggest you document that you used 0.5 sq. cm. of product and wasted 4.0 sq. cm. of product. If you used more than that because of overlapping the wound, adjust accordingly. I suggest purchasing and billing for the smallest size available that will cover your wound.


 


Jeffrey D Lehrman, DPM, Springfield, PA


 


For information on Codingline subscriptions, click here

02/14/2017    

CODINGLINE CORNER


Query:  CPT 11056 Denial 


 


I submitted a claim with a “Q8” on both the CPT 11720 and the CPT 11056, with only one “-59” modifier applied to CPT 11720. Again, Palmetto denied the claim. The reason for the denial remains the same, “missing/incomplete/invalid attending primary identifier” and “missing/incomplete/invalid last seen/visit date.” I listed myself as the ordering physician on one claim, and as the supervising physician on the other claim (both denied). I put my license number in the “ordering physician ID” field, thinking this may fix the problem, but it was still denied. I have so far not ever been successful in getting Palmetto to pay for callus care. 


 


Troy Harris, DPM, Swansboro, NC


 


Response: CPT 11056 requires not only a “Q” class findings modifier, but you also must list the PCP who is managing the conditions for the patient, as well as the date last seen by that provider.  It must have been within 6 months of your visit. You cannot use yourself.


 


Anna Sanders, Clarksville, TN


 


For information on Codingline subscriptions, click here

02/10/2017    

CODINGLINE CORNER


Query: Plantarflexed Metatarsal


 


I have a new Medicare patient who presented with a plantarflexed 5th metatarsal and localized bursitis. I evaluated the patient and gave an injection of lidocaine and dexamethasone, along with an off-loading pad. What ICD-10 and CPT codes would you suggest?


 


Adam Klein, DPM, Lynbrook, NY


 


Response: The ICD-10 code I suggest for the plantarflexed metatarsal, I believe, would be: M21.6X1  Acquired foot deformity, right; or M21.6X2 Acquired foot deformity, left.


 


For the injection, I would use CPT code 20600 – presuming the injection is in the foot with the ICD-10 code M77.51, other enthesopathy of right foot; or M77.52, other enthesopathy of left foot, whichever is appropriate.


 


Be sure to bill for the dexamethasone using HCPCS J1100 (dexamethasone 4 mg/ml [1 unit]).


 


Joseph Borreggine, DPM, Charleston, IL


 


For information on Codingline subscriptions, click here

02/07/2017    

CODINGLINE CORNER


Query: Billing CPT 11721


 


I am billing CPT 11721 with ICD-10 L60.3 (nail dystrophy) as the primary and M79.671 (pain in right foot) as the secondary. I can’t get this claim to pass the scrubbing process. However, these ICD-10 codes are listed as billable for Medicare. Can anyone help with this problem?


 


Robson Araujo, DPM, Boaz, AL


 


Response: Since you are in Alabama, you would be billing Cahaba Medicare, as are we. The primary diagnosis code for CPT 11721 should be B35.1, onychomycosis.


 


Since you are using pain as the secondary code, and you are billing for 6 or more nails, then you should include pain for both right and left feet if that pain exists. We generally use M79.674 and M79.675 for pain in toes right and left. This combination should get the procedure paid. As always, make sure your notes support your claim.


 


Katherine Sharp, Woodbury, TN


 


For information on Codingline subscriptions, click here

02/04/2017    

CODINGLINE CORNER


Query: Bunionectomy with Exostectomy Hallux Base


 


I performed a modified McBride-type bunionectomy with sesamoid release, etc. and clean-up of an arthritic hallux phalangeal base due to degenerative changes. I am being denied the CPT 28124 hallux exostectomy because the two procedures were done through the same incision – which is true. However, I was under the impression that since the surgery was done on two separate bones and billed as two separate sites (foot for CPT 28292 and 1st toe for CPT 28124) that both should be payable. Am I wrong in my thinking?  


 


Pete Smith, DPM Lancaster, PA


 


Response: If I understand your description of the surgery, you remodeled the base of the proximal phalanx of the hallux. If this is true, you should not expect any additional reimbursement beyond the bunion repair. The arthoplasty of the first metatarsal head for bunion repair includes both sides of the joint.


 


If there were very unusual findings and complex repair (i.e., cyst in bone requiring curettage and bone packing requiring significantly more work than the bunionectomy value), then you would be entitled to additional payment with the addition of a “-22” modifier.


 


Howard Zlotoff, DPM, Camp Hill, PA


 


For information on Codingline subscriptions, click here

01/31/2017    

CODINGLINE CORNER


Query: Billing Injections with Office Visits


 


If an established patient is seen for a painful condition and is given an injection and no other chief complaint is stated, can the patient be billed for an office visit as well? If so, is it a level 2 or level 3 visit?


 


Danielle LaLonde, Belvidere, NJ


 


Response: The answer is, it depends. If an established patient presents with a new complaint that ultimately results in the patient receiving an injection as treatment, presuming the documentation is supportive (“significant, separately identifiable evaluation and management”), the doctor deserves to be reimbursed for both the work-up and the treatment.


 


If, however, the patient is returning for a subsequent injection (not unexpected), and there is little significant new E/M findings (i.e., no new interval key elements) – the doctor expected to give that 2nd or 3rd injection (previous medical decision-making) – then only the injection and therapeutic medication are reimbursable. The level of E/M is based on significant, separately identifiable new findings (from the previous encounters). One would think a new condition would have a greater need for history, exam, and/or medical decision-making than an established condition that has minimal new information that impacts the evaluation prior to injection performance. Ultimately, the level of the E/M service would depend on medical necessity, interval change from the previous encounters, and the documentation.


 


Tony Poggio, DPM, Alameda, CA


 


For information on Codingline subscriptions, click here

01/28/2017    

CODINGLINE CORNER


Query: New Bunionectomy with Implant Coding


 


Now that CPT has revised the bunionectomy codes for 2017, deleting CPT 28293 (correction, hallux valgus [bunion], with or without sesamoidectomy; resection of joint with implant), what is the new code for insertion of a total 1st metatarsal-phalangeal joint implant? There seems to be some confusion.


 


Mike King, DPM, Alpharetta, GA


 


Response: If the 1st metatarsal-phalangeal joint implant is inserted as part of a hallux rigidus repair, the appropriate code for 2017 is CPT 28291 (hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant).


 


Jeffrey Lehrman, DPM, Springfield, PA


For information on Codingline subscriptions, click here


01/24/2017    

CODINGLINE CORNER


Query: Billing Injections with Office Visits


 


If an established patient is seen for a painful condition and is given an injection and no other chief complaint is stated, can the patient be billed for an office visit as well? If so, level 2 or level 3 visit?


 


Danielle LaLonde, Belvidere, NJ


 


Response: The answer is, it depends.


 


If an established patient presents with a new complaint that ultimately results in the patient receiving an injection as treatment, presuming the documentation is supportive (“significant, separately identifiable evaluation and management”), the doctor deserves to be reimbursed for both the work-up and the treatment.


 


If, however, the patient is returning for a subsequent injection (not unexpected), and there is little significant new E/M findings (i.e., no new interval key elements) – the doctor expected to give that 2nd or 3rd injection (previous medical decision-making) – then only the injection and therapeutic medication are reimbursable. The level of E/M is based on significant, separately identifiable new findings (from the previous encounters). One would think a new condition would have a greater need for history, exam, and/or medical decision-making than an established condition that has minimal new information that impacts the evaluation prior to injection performance. Ultimately, the level of the E/M service would depend on medical necessity, interval change from the previous encounters, and the documentation.


 


Tony Poggio, DPM, Alameda, CA


 


For information on Codingline subscriptions, click here

01/20/2017    

CODINGLINE CORNER


Query: Nerve Biopsies


 


Can anyone please tell me what diagnosis you are using for Medicare patients who have a nerve biopsy done?


 


Danielle LaLonde, Belvidere, NJ


 


Response: We have used peripheral neuropathy as the diagnosis in the past. Of course, with ICD-9, we could use ICD-9 356.9, but that crosswalks to G60.9 which is an unspecified code in ICD-10. I would look at the range G57-G60 and pick the most appropriate code that describes the patient’s condition.


 


You could also check in the APMA Coding Resource Center by entering the CPT code, and looking to see what is offered under CPT to ICD-10 suggested links. There will be suggestions for diagnosis coding for most procedure CPT codes. Unfortunately, if you are using CPT 94795 for your biopsy of nerve code, there are no suggested diagnosis codes.


 


Katherine Sharp, Woodbury, TN


 


For information on Codingline subscriptions, click here

01/18/2017    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Tom Silver, DPM


 


We finally addressed this problem of unmet deductibles last January when we started asking patients for their credit card, to keep it "temporarily" on file.  Our policy states that once we know what their insurance allows, we will notify the patient of their balance by phone as to the amount we will be applying to their credit card (unless they want to make other arrangements).  


 


Since some patients refuse to give us their credit card, I need to decide if we should start asking for a percent of their charges at the time of service, since they will have to pay a certain amount out of pocket anyways when their deductible isn't met.


 


Tom Silver, DPM, Minneapolis, MN

01/17/2017    

CODINGLINE CORNER


Query: PQRS for 2017


 


Has PQRS been completely eliminated for 2017 in lieu of CMS’s implementation of the Quality Payment Program and MIPS? For 2017, do we need to still track the PQRS measures using the “G” codes and other codes established for PQRS in the past?


 


Joseph Borreggine, DPM, Charleston, IL


 


Response: PQRS no longer exists in 2017. MACRA began January 1, 2017. PQRS and Meaningful Use are over. One way to participate in MACRA is through the Merit-Based Incentive Payment System (MIPS).


 


One of the three reporting categories of MIPS in 2017 is “Quality”. Full MIPS participation requires reporting on 6 quality measures. These quality measures are very similar or identical to the PQRS measures that you are referring to, some of which are reported using “G” codes.


 


Jeffrey Lehrman, DPM, Springfield, PA


 


For information on Codingline subscriptions, click here

01/16/2017    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Charles Morelli, DPM


 


My opinion on this practice is a simple one. CHARGE YOUR PATIENTS FOR THEIR DEDUCTIBLES. Most of use have EMR software that connects directly with Medicare and many commercial carriers, and lets you know exactly what a patient's deductible is. You can tell your patient this information prior to their appointment, assuming you call patients to remind them of their appointments, or they can be told when they arrive and let them know that their deductible needs to be paid BEFORE they are seen (as well as their co-pays).


 


When we see patients in November/December and they make a follow-up appointment for the new year, we tell them at that time that they will be paying for their next visit (assuming that the deductible has not been met previously or they do not have a secondary carrier that picks up that amount). Stop working for free and stop being afraid to ask (or tell) your patients that they need to pay for their treatments. 


 


Charles Morelli, DPM, Mamaroneck, NY

01/13/2017    

CODINGLINE CORNER


Query: Holding Billing at the Beginning of the Year


 


I have read in the past, opinions on the pros and cons of holding your billing for the first 1-2 months of a new year to avoid hitting everyone’s deductible. Do readers on this forum have an opinion on this practice?


 


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


 


Response: You should check with your payers because I have found that this actually may be against your contract in many cases.


 


Anna Sanders, Clarksville, TN


 


For information on Codingline subscriptions, click here

01/10/2017    

CODINGLINE CORNER


Query: Bunionectomy with Implant Coding


 


Now that CPT has revised the bunionectomy codes for 2017, deleting CPT 28293 (correction, hallux valgus [bunion], with or without sesamoidectomy; resection of joint with implant), what is the new code for insertion of a total 1st metatarsal-phalangeal joint implant?


 


Mike King, DPM, Alpharetta, GA


 


Response: If the 1st metatarsal-phalangeal joint implant is inserted as part of a hallux rigidus repair, the appropriate code for 2017 is CPT 28291 (hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant).


 


Jeffrey Lehrman, DPM, Springfield, PA


 


For information on Codingline subscriptions, click here

01/09/2017    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Jerry Peterson, DPM


 


Before you go calling the State Board, I suggest that you contact your state association’s representative on legislative activities. I am sure they have a committee and chairperson on this. If not, ask the component president. Going to the state could cause the opening of a can of worms when you don’t ask the right people the correct question.


 


When you deal with government or any regulatory agency, you always want to know the answer BEFORE you ask the question! There may be better people to ask.


 


Jerry Peterson, DPM, West Linn, OR

01/06/2017    

CODINGLINE CORNER


Query: Staff Performing CPT 17110


 


Can the office staff perform CPT 17110 (destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) and bill this code without the doctor being in the office?


 


Anna Sanders, Clarksville, TN


 


Response: In my opinion, the answer would be a resounding “no.” In the State of Illinois, if an unlicensed staff member provides procedural or surgical treatment as described in the post, it would be practicing medicine without a license. Not only would it be illegal to perform said treatment, but also to bill an insurance carrier for the surgical services performed by an unlicensed member of the doctor’s staff.


 


I recommend you check with your state licensing board (my response may not be the same for your state). If you do check with your licensing board and get a response, I would appreciate you sharing it with us.


 


Joseph Borreggine, DPM, Charleston, IL


 


For information on Codingline subscriptions, click here

01/03/2017    

CODINGLINE CORNER


Query: Covering a Colleague's Office


 


I have a colleague who is recovering from surgery and needs help covering in his office. I would like to help, volunteering my time on a limited basis. Would there be any ramifications if I went to his office to treat his patients and just allow the office to bill under his Medicare number? I am not asking for any remuneration. I’m asking this question more regarding the legality as well as any malpractice coverage or Medicare liabilities.


 


Codingline Archive Question


 


Response: His staff billing for the services will bill those services just as if your colleague had provided the service. They will add a “Q6” modifier to the claim codes so that Medicare would know a locums (that’s you) was providing this on a temporary basis (no more than 60 days).


 


This happens a lot and that is very generous and commendable of you to help your colleague like that.


 


Don Self, Whitehouse, TX


 


For information on Codingline subscriptions, click here

12/30/2016    

CODINGLINE CORNER


Query: Must Sensation be Absent to Bill *Q9*?


 


I would like to bill Medicare for CPT 11721 on a patient with type 2 diabetes, who has one absent pedal pulse and has completely intact light touch sensation in her feet. She, however, reports burning and tingling of her feet. As long as I document a primary care provider visit within the past 6 months, will this be covered using a "Q9" modifier? 


 


Troy Harris, DPM, Swansboro, NC 


 


Response: The "Q9" modifier represents the presumption of coverage when the physician rendering the routine foot care has identified one class B and two class C findings. 


 


You note that the patient has one absent pulse (either dorsalis pedis or posterior tibial), so the single class B finding is met. 


 


The class C findings options are: Claudication; Temperature changes (e.g., cold feet); Edema; Paresthesias; and Burning. 


 


The tingling sensations described by the patient would qualify for paresthesia. So, the patient describes (and you documented) both paresthesias and burning in the feet - two class C findings. The presumption of coverage ("Q9") appears to have been met. By the way, you still would need to document "the evidence available discloses certain physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement" as well as qualifying diagnoses for your records and claims. 


 


Tony Poggio, DPM, Alameda, CA 


 


For information on Codingline subscriptions, click here

12/29/2016    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1A



From: Harry Goldsmith, DPM


 


I disagree with Dr. Landsman. If you are performing a destruction of neuroma (I am presuming it is an interdigital [Morton's-type neuroma]), you would look to the nerve destruction codes. In this case, CPT 64632 is described as "destruction by neurolytic agent; plantar common digital nerve." CPT 64632 falls under the heading "Destruction by Neurolytic Agent (e.g., Chemical, Thermal, Electrical or Radiofrequency)."


 


The original post in Codingline noted the author was using the Neurotherm unit for radiofrequency destruction. However, the Neurotherm website/page notes that the unit is a radiofrequency generator, delivering "pulsed or pulsed dosed treatments to painful nerve sites to help manage chronic pain."


 


CPT instructions for the “destruction by neurolytic agent” section specifically say, "Do not report a code labeled as destruction when using therapies that are not destructive of the target nerve (e.g., pulsed radiofrequency), use CPT 64999." Unless there is something about the Neurotherm machine's radiofrequency delivery beyond what the company included in their website, the proper code to use in this case is CPT 64999 (unlisted procedure, nervous system). 


 


Harry Goldsmith, DPM, Cerritos, CA

12/28/2016    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Adam Landsman, DPM, PhD


 


The proper code treatment of a neuroma using a Neurotherm machine is CPT 64640.


 


Adam Landsman, DPM, PhD, Boston, MA

12/27/2016    

CODINGLINE CORNER


Query: Radiofrequency Coding


 


I have a Medicare (Nassau County, New York) patient with a painful neuroma. How would one bill for radiofrequency destruction using a Neurotherm machine in terms of CPT and diagnostic coding? 


 


David Sands, DPM, Great Neck, NY


 


Response: The Neurotherm machine use involves no specific CPT code use that I am aware of. You are in New York and your NGS is your Medicare contractor. I looked on their website for specific neuroma coding guidance and did not see any.  


 


For destruction, when you think neuroma, you look in the nerve section, for example, CPT 64632 (destruction by neurolytic agent; plantar common digital nerve). This means you are using a neurolytic agent that is destructive. I do not believe the Neurotherm machine meets the description. If it is not destructive but therapeutic, you would use a code like CPT 64999 (unlisted procedure, nervous system). This therapy is probably going to a CASH service. 


 


You did not give the exact anatomical location for the neuroma, so the most common neuroma ICD-10 codes are: 


G57.61 Lesion of plantar nerve, right lower limb 


G57.62 Lesion of plantar nerve, left lower limb 


G57.63 Lesion of plantar nerve, bilateral lower limbs 


 


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


 


For information on Codingline subscriptions, click here

12/23/2016    

CODINGLINE CORNER


Query: Debridement During a Global Period


 


We have a patient who is in the post-op global period for a toe amputation. At his last visit, he presented a new problem requiring the doctor to perform CPT 11042 (debridement, to and including subcutaneous tissue). Is it correct to bill CPT 11042 with both modifiers "-79" and "-58"? 


 


Vanessa Sloan, Effingham, IL 


 


Response: A toe amputation has a 90-day global so debridement of the amputation site within the global period may be included in the amputation global fee allowance depending on the payer. This is especially true for Medicare if the procedure is not performed in an operating room. 


 


Your chart note must be very clear as to what you mean by "he presented with a new problem." I wasn't clear as to whether the ulcer was at the same or a different site than the amputation. If it was the same site, when the patient stubbed his foot, did the wound open resulting in the need for the debridement or was the amputation site in need of local clean up despite the contusion? 


 


The "-58" modifier implies a staged or related procedure while the "-79" modifier is reserved for a completely unrelated procedure. You cannot apply both to a procedure. 


 


Tony Poggio, DPM, Alameda CA 


 


For information on Codingline subscriptions, click here

12/20/2016    

CODINGLINE CORNER


RE: Bone Graft at Bunionectomy Site


 


Is CPT 20957 (bone graft with microvascular anastomosis; metatarsal) an appropriate code to use when an autologous bone graft for the bunionectomy site was used to rotate the cartilage of the head of the first metatarsal for treatment of hallux limitus/valgus? Can we also bill CPT 28296? 


 


Name Withheld by Moderator


 


Response: Typically, rather than actually performing a microvascular anastomosis, surgeons use an autograph (from the same metatarsal) to address hallux limitus. If that is the case here, in my opinion, it is globally included in CPT 28296. 


 


Rick Horsman, DPM, Olympia, WA 


 


For information on Codingline subscriptions, click here

12/16/2016    

CODINGLINE CORNER


Query: 2017 Medicare Digital X-Ray Requirements


 


If we are taking x-rays digitally as of January 1, 2017, no change is required to our current billing for x-rays. If we are NOT taking x-rays digitally as of January 1, 2017, then we need to add a modifier onto the technical component. Is the modifier actually "XX" or is that just used as a placeholder above? 


 


Michael Nirenberg, DPM, Merrillville, IN


 


Response: Beginning January 1, 2017, CMS will be reducing by 20% of the Medicare fee schedule allowance the TECHNICAL COMPONENT (TC) allowance for any x-rays billed that still use film. From January 1, 2017 on, doctors/practices taking and billing for x-rays that use film will be required to append an "FX" modifier to the global x-ray code to indicate they are still using film. 


 


Beginning 2018, practices using "computed radiology" (CR) where imaging is obtain via a cassette or imaging plate, the final rule "provides a 7% reduction in Medicare x-ray payments. CMS promises more details prior to the 2018 implementation date. So, to answer your question, if you are using a digital x-ray system in 2017 and NOT obtaining your radiologic image on film, you do not have to do anything. You would bill as you previously have. If you are still using film, you add the "FX" modifier to your global x-ray code. For example, CPT 73630-FX-LT. Medicare will "automatically" reduce by 20% the technical component portion allowance for you. 


 


Tony Poggio, DPM, Alameda, CA 


 


For information on Codingline subscriptions, click here
Mycoside3