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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:


11/22/2014    

CODINGLINE CORNER


Query: Which code: CPT 28126 or CPT 28160?


 


Which code would be most appropriate to bill when the prominent head or base of the phalanx is partially removed due to a painful overlying corn, CPT 28126 or CPT 28160? 


 


Lynn Stafford, DPM, Fort Wayne, IN


 


Response: Let's look at the two CPT codes you asked about 


 


1) CPT 28126 - resection, partial or complete, phalangeal base, each toe 


2) CPT 28160 - hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each 


 


So, if you are removing an interphalangeal joint, meaning the base of the middle phalanx and the head of the proximal phalanx, then it is CPT 28160. 


 


If correcting the hammertoe, then it would be CPT 28285 -correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy). This procedure allows for removal of part of the phalanx, i.e., the head of the proximal phalanx. If just doing the phalangeal base, then use CPT 28126. 


 


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


 



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11/19/2014    

CODINGLINE CORNER


Query: Use of Multiple Skin Substitutes


 


If you apply Apligraf to a wound 5 times (separate surgical sessions over time), the maximum allowed applications by my Medicare contractor, but fail to get closure, would you be allowed to switch to a different skin substitute product (e.g., Dermagraft) to achieve closure? If so, when would it be acceptable (reimbursable)? 


 


Louis Cappa, DPM, New Windsor, NY


 


Response: I think this depends on your LCD. Make sure your documentation supports the need and explains why you think switching to a different product will make a difference. I would try to pre-certify or contact Medicare before moving forward. 


 


Jeffrey Lehrman, DPM, Springfield, PA 


 



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11/15/2014    

CODINGLINE CORNER


Query: AFO Replacement After 2 Years


 


I am presently treating a patient who was fitted with an AFO after a CVA around 2 years ago. He was fitted in a hospital after the stroke. The brace is still in a good shape, but the patient's leg is more swollen now and as a result, he developed pressure blister in a few places. This makes him uncomfortable. I tried using padding but it doesn't help. In my opinion, this patient needs to be re-cast for a new device. Would Medicare DME pay for a new brace if it has been less than 5 years since the old one was fabricated? Do I need to send medical records in order to prove my point? 


 


Boris Raginsky, DPM, East Brunswick, NJ


 


Response: While, yes, it is true that Medicare says the brace should have a lifetime for a period of 5 years, if there is medical necessity (you mentioned that the AFO no longer conforms to the patient's leg anatomy) and if the device cannot be adjusted, prescribe a new one. Have the patient sign an advance beneficiary notice (ABN) because of the 5-year rule. As long as you document why a new device is medically necessary, you should be reimbursed for dispensing a new AFO. 


 


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


 



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11/13/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Andrew Carver, DPM


 


This argument about "night splints" seems to be quite a moot point, as part of the methodology of improving or curing plantar fasciitis pain. Every time I have surgically touched the plantar fascia, I realized that that tissue cannot be "stretched" longitudinally. I believe the 'night splint' was the invention of the foot and ankle orthopedic community because they did not want to admit that orthoses were actually the best treatment. Podiatry developed the orthotic. 


 


In my opinion, a night splint only affords 'compression' to the area at night - therefore disallowing the edema to the plantar heel extra-cellular space during non-weight-bearing. Patients get up and walk on the heel in the morning and most often the pain greatly improves. The swelling that occurs because of this at night causes ALL the 'morning heel pain.' It just so happens that the night splint disallows this swelling; therefore patients and practitioners surmise that the night splint is stretching the fascia. I do not think so.


 


I put my fasciitis patients in a 'Copper foot/heel sleeve' at night and get the same pain improvement that the night splint affords. I just do not believe that there is any way to stretch the plantar fascia  (Well, maybe with ECSW).


 


Andrew Carver, DPM, Washington, DC, andrewlcarver@gmail.com

11/12/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Ken Meisler, DPM


 


Dr. Ribotsky makes it sound like every patient who has bilateral plantar fascitis should use two night splints. I have treated thousands of patients with plantar fasciitis, many bilateral, and almost every patient who is able to sleep with a night splint finds it very helpful. I always start with one night splint and when they come in for a follow-up in a few weeks, I offer a second one. I have found that greater than 90% of the patients do NOT want to use a second night splint, even if the first one is helping significantly.  


 


I tell patients with bilateral plantar fasciitis to use the splint on the leg that has the more severe plantar fasciitis and, then when that foot is the same as the other foot, to alternate legs each night. Patients seem to rather have their fasciitis get better a little more slowly than sleep with two night splints.  


 


90% of the patients I treat for plantar fasciitis are NOT seniors. Perhaps Dr. Ribotsky has an older population and they sleep more soundly, or maybe people in Florida just sleep better than New Yorkers, but I always ask knowing what the patient will say and still get a laugh at the look on their faces at the thought of sleeping with two night splints.


 


Ken Meisler, DPM, NY, NY, kenmeisler@gmail.com

11/12/2014    

CODINGLINE CORNER


Query: Tendon Repair with Use of GraftJacket


 


Please advise as to the most appropriate code(s) for repair of a partially torn posterior tibial tendon with use of GraftJacket. 


 


Stuart Honick, DPM, Mays Landing, NJ


 


Response: The use of GraftJacket does not influence the tendon repair code you choose (in this case, CPT 28200 - repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon). There is no specific code for the application of GraftJacket in tendon repair. Typically, unless you get authorization for additional allowance pre-op, you might very well find that there is no extra allowance for its use in reinforcing a tendon repair. 


 


Some surgeons have added a "-22" increased procedural services modifier to the repair code. Others have billed the unlisted foot/toe code, CPT 28899. I can't tell you if they have been successful. 


 


Tony Poggio, DPM, Alameda, CA 


 



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11/11/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Bret Ribotsky, DPM


 


I disagree with my friend Dr. Kesselman on his response about having a patient split the wearing of a night splint between legs. Really? Have we all just bowed down to the "insurance gods" and given in? I am sure if Paul were to come down with plantar fasciitis, he would sleep with two splints.  


 


Maybe the next time I get my eyes checked and they find only a problem with one eye, the doctor will prescribe a monocle. Maybe if I have a patient with a wound on both legs, I could share the VAC one day left, one day right. Please, we must never lose sight of the fact that we must do what is best for the patient. If the insurance company only wants to pay for one night splint, I leave it up to the patient to complain to the insurance gods. I tell the patient that this is the cost of the second splint and have them get it. The motivated patient wants to get better quickly, and the physician who treats patients to a speedy recovery will have a significant advantage today and in the future.


 


Bret Ribotsky, DPM, Boca Raton, FL, Ribotsky@gmail.com

11/08/2014    

CODINGLINE CORNER


Query: Bilateral Night Splints


 


When a patient presents with bilateral plantar fasciitis, is it acceptable to dispense and bill for two night splints (L4396)? 


 


Charles Perry, DPM, Cambridge, OH


 


Response: While the policy would allow for dispensing bilateral night splints, I have in the past only dispensed a single night splint to any given patient, telling them to wear it on the right side on even days, the left side on odd days, or whatever means of reminder works for them. I do not suggest dispensing bilateral night splints. 


 


You need to separate medical necessity and reimbursement policy from practicality. Do you really expect the patient to remove the night splints (both of them) at 2 AM if they need to go to the bathroom and then re-apply them? If kept on, one of these splints is difficult enough to sleep with and navigate; can you imagine two? 


 


Paul Kesselman, DPM, Woodside, NY 


 



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11/05/2014    

CODINGLINE CORNER


Query:  Ulcer & Ostectomy Coding


 


What code would I use for excision of ulcer with ostectomy (1st metatarsal head)? 


 


Diane M. Phalen, DPM, San Marcos, TX


 


Response: It depends on the specific circumstances. A partial exostectomy would be coded as CPT 28288, CPT 28122, CPT 28104, or, if the entire metatarsal head was excised, CPT 28111. Where was the ulcer? If it was overlying the incision area (where, for example, a simple ellipse would remove all the non-viable tissue), then typically that procedure would be a component of the more comprehensive bone resection. 


 


Tony Poggio, DPM, Alameda, CA 


 



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11/03/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1B



From: Ivar E. Roth, DPM, MPH 


 


After reading what CMS states concerning documentation,  I was wondering if the following scenerio would qualify for neuroma injections with alcohol for sclerosing the nerve? “Ultrasound guidance was used to accurately inject into the nerve without injecting the vasculature or muscle, the neuroma was not injected. The sclerosing agent was injected just proximal to the neuroma, into the 2mm nerve.” Other issues are: how would you inject .5cc of anything into a 2mm nerve?  


 


Lastly, this podiatrist used this code seven times in a row over the course of the treatment for the injection, and was paid $250 each time for the use of the ultrasound. Does this make sense? I think that one would figure out after the first time where to inject for the future injections, and not need to do this SEVEN times. Am I wrong?


 


Ivar E. Roth, DPM, MPH, Newport Beach, CA, ifabs@earthlink.net 

11/03/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1A



From: Elliot Udell, DPM


 


Ms. Merkow states that one must document the following prior to giving an ultrasound-guided injection: "initial attempt to inject failed; the patient's obesity impairs your ability to inject accurately; etc."


 


The literature is split on whether the use of ultrasound guidance in giving a musculoskeletal injection yields better results. If a doctor subscribes, however, to the studies that show that ultrasound guidance does improve clinical outcomes, he or she should not have to show "failed" attempts, or a "patient's obesity", in order to be reimbursed for the procedures.


 


Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

11/01/2014    

CODINGLINE CORNER


Query: Documentation Guidelines: Ultrasound-Guided Injections


 


After unsuccessfully searching the CMS website for this information, we are looking for assistance. Can someone guide us to a resource that will give us the documentation requirements for ultrasound-guided injections? Do we need to develop a separate form for this procedure? We understand that CMS will be heavily auditing these procedures in the future and want to be correctly documenting. 


 


David Sandberg, DPM, Knoxville, TN


 


Response: You may be frustrated by CMS because they are updating LCDs at this time and many are not listed. I can't cite a resource for that reason, however permanent copies of the recorded images must be maintained in the patient record when ultrasound is used to guide a procedure. Images can be stored as printed or digital images. The reported description can be dictated as a separate procedure or as part of the procedure for which the guidance is used, but it MUST be included. Your documentation must indicate medical necessity (i.e., initial attempt to inject failed; the patient's obesity impairs your ability to inject accurately; etc.). Obviously, you must select a diagnostic code that determines medical necessity. 


 


All of the above must be included in the patient's record AND must be readily submitted to the payer upon request. Because we include medical necessity in our records all of the time for routine foot care, motor vehicle, and Workers' Comp claims, this isn't as bad or ominous as it sounds. 


 


Lisa Merkow, CPC, Largo, FL 


 



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10/29/2014    

CODINGLINE CORNER


Query: Repair of Non-union Toe


 


I cannot find a code for a surgery performed on a patient. The surgery was to repair a non-union proximal interphalangeal joint. There is a code for a non-union repair of tarsal bones (CPT 28320), but not of the interphalangeal joint. What code do you suggest? 


 


Walter Warren, DPM, Seymour, IN


 


Response: The closest thing I can relate for surgery to repair a non-union proximal interphalangeal joint is CPT 28525 - open treatment of fracture, phalanx or phalanges, other than great toe, with or without internal or external fixation, each. An interphalangeal joint involves two phalanges; this code allows for the repair of phalanges in my opinion. 


 


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


 



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10/25/2014    

CODINGLINE CORNER


Query: Correct Diagnosis for CPT 97760 


 


What diagnosis is used for orthotic training, CPT 99760 - orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes? Is it billed bilateral also? 


 


Stanley Luksenburg, DPM, Fairview Park, OH


 


Response: The diagnosis code you would use in a dispensing/post-dispensing encounter would be the one that describes the condition or symptoms presented by the patient that led you to dispense the orthosis in the first place. ICD-9 does not have an "encounter for" code for the purpose of training the patient on a DME. 


 


Be aware that Medicare includes the dispensing, fitting, and "training" in the value of the orthosis. You would not separately bill Medicare CPT 97760. Non-Medicare payers, it has been my experience, if aware that you billing CPT 97760 in conjunction for custom foot orthosis dispensing, will not reimburse you CPT 97760. They may, depending on the individual payer's policy, reimburse you for a low level E/M service. 


 


If you dispensed two lower extremity orthoses for some reason (other than custom foot orthotics), you would bill CPT 99760 based on time - 15 minute increments of medically necessary training - not for each device. 


 


Harry Goldsmith, DPM, Cerritos, CA


 



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10/22/2014    

CODINGLINE CORNER


Query: Total Contact Cast Code


 


I know that the application code for a total contact cast is CPT 29445, but what code do you bill for the supplies? The rep we have been getting the supplies through advised us to use Q4050 (cast supplies, for unlisted types and materials of casts), but I see other doctors on Codingline are using Q4038 (cast supplies, short leg cast, adult [11 years +], fiberglass). Which code is the correct code? If you use Q4050, what would you put in box 19 for Medicare? 


 


Brittany, Billing, Office of Jan Tepper, DPM, Upland, CA


 


Response: You have two choices when it comes to the application of fiberglass because you did not state what plan is being billed. If the patient has Medicare, then your cast supply choice is Q4038 (cast supplies, short leg cast, adult [11 years +], fiberglass). If the patient has private insurance, you would bill A4590 (special casting material [e.g., fiberglass]). CPT 29445 nationally gets $139, Q4038 gets $37.55, and A4590 gets $? (depends on private carrier and the number of casting rolls used). 


 


Q4038 is described as "supplies", not "supply", so if more than one roll of fiberglass is used, Medicare only pays for a single (1) unit. For non-Medicare payers, typically, A4590 is a "per unit" charge, so more than one roll gets more than one unit. 


 


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


 



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10/18/2014    

CODINGLINE CORNER


Query: Stage 2 Meaningful Use Hardship Extension


 


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


 


Don Ambroziak, DPM, Lexington, KY


 


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


 


Jeffrey Lehrman, DPM, Springfield, PA


 



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10/15/2014    

CODINGLINE CORNER


Query: Not Meeting Criteria for Diabetic Inserts 


 


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


 


Peyman Elison, DPM, Surprise, AZ


 


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


 


Harry Goldsmith, DPM, Cerritos, CA 


 



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10/11/2014    

CODINGLINE CORNER


 Query: Not Meeting Criteria for Diabetic Inserts


 


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


 


Peyman Elison, DPM, Surprise, AZ 


 


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


 


Harry Goldsmith, DPM, Cerritos, CA 


 



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10/08/2014    

CODINGLINE CORNER


Query: Codes Not Covered by Medicaid


 


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


 


Dawn Dryden, DPM, Batavia, NY


 


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


 


Paul Kesselman, DPM, Woodside, NY 


 



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10/04/2014    

CODINGLINE CORNER


Query: Re-Evaluating At-Risk Status


 


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


 


Charles Perry, DPM , Cambridge, OH


 


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


 


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


 


Paul Kinberg, DPM, Dallas, TX 


 



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10/01/2014    

CODINGLINE CORNER


Query: Billing Ulcer Debridement with Follow-Up Hospital Care


 


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


 


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


 


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


 


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


 



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09/27/2014    

CODINGLINE CORNER


Query: Coding Extensor Tendon Repair with Graft 


 


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


 


Robert Anderson, DPM, Brewer, ME


 


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


 


Howard Zlotoff DPM,Camp Hill, PA 


 



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09/24/2014    

CODINGLINE CORNER


Query: PRP Injection Payment Losses


 


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


 


Terri Phillips, CPC, Tulsa, OK


 


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


 


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


 


Joan Gilhooly, CPC, CPCO, Lebanon, OH 


 



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09/20/2014    

CODINGLINE CORNER


Query: Revisiting Subtalar Arthroereisis Coding


 


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


 


Mark Bauman, DPM, Marlton, NJ


 


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


 


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


 



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09/17/2014    

CODINGLINE CORNER


Query: CPT 11750 vs CPT 11765


 


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


 


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


 


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


 


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


 


Paul Kinberg, DPM, Dallas, TX 


 



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