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02/27/2010    

CODINGLINE CORNER

Query: Billing Lapidus/Akin


The doctor performed a Lapidus-type bunionectomy (CPT 28297) and an Akin-type osteotomy (CPT 28310) on a patient. CPT 28310 was denied as inclusive to the Lapidus-type procedure. Does anyone have any suggestions on how I should have billed the procedures? Or how I should appeal the denial?


Sarah Avilleira, Office of Peter A. Wishnie, DPM, Piscataway, NJ


Response: The correct billing for a Lapidus-type bunionectomy and an Akin-type osteotomy is:


#1 CPT 28297 (correction, hallux valgus (bunion), with or without sesamoidectomy; Lapidus type procedure); and CPT 28310-59 (osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe). or


#2 CPT 28740 (arthrodesis, midtarsal or tarsometatarsal, single joint); and CPT 28298-59 (correction, hallux valgus (bunion), with or without sesamoidectomy; by phalangeal osteotomy).


Both coding methods are correct. By the way, the value of coding example #2 is higher than #1. The payer was incorrect in denying CPT 28310 as inclusive (unless you did not add a "-59" modifier to the code). I recommend you appeal with submission of a corrected claim with either one of the coding examples listed above.


It should be noted that CPT 28310 is a designated "separate procedure" code. Separate procedure means that in order to be independently reimbursed, the procedure must not be an integral part of a comprehensive procedure being billed. CPT 28310 needs to be distinct, and in coding example #1, it is.


Harry Goldsmith, DPM, Cerritos, CA


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Other messages in this thread:


06/27/2017    

CODINGLINE CORNER



Query: Airwalkers and Fracture Care


 


For fractures being billed to Blue Cross Blue Shield insurance, can I bill the Airwalker or CAM Walker separately from fracture care global code?


 


Matthew German, DPM, Livonia, MI


 


Response: Yes, you can. Casting (subsequent, not initial casting), DME, casting supplies, and x-rays are all outside of the global payment for fracture care.


 


You can bill separately for all such products within the normal guidelines of medical necessity and per the payer’s plan.


 


Mike King, DPM, Roswell, GA



 


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06/23/2017    

CODINGLINE CORNER



Query: Bunion Correction with Joint Implant


 


I was given the code, CPT 28293 (bunionectomy with implant), but when I looked up the code in the APMA Coding Resource Center, it says the code has been replaced with CPT 28291 (hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant), but it is not coming up as a valid code in our EMR. When I look in the podiatry coding book, CPT 28291 is not a listed code. Could you please let me know which code I should be using?


 


W. Anthony Wakim, DPM, Brockton, MA


 


Response: The code, CPT 28291, from the APMA Coding Resource Center is the correct code. The problem with your EMR is that it’s not updated, and you need to find a way to update your CPT code directory and eliminate the old code, replacing it with the new code.


 


CPT 28293 was deleted as of January 1, 2017. CPT 29891 is a cheilectomy with implant code.


 


Joseph Borreggine, DPM, Charleston, IL



 


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06/20/2017    

CODINGLINE CORNER



Query: Verruca Laser Surgical Coding


 


How would you bill laser surgery that included destruction of “over 6 islands, many colonies” of warts’?


 


Michael Giordano, DPM, Rochester, NY


 


Response: When the issue is the “destruction of warts” by laser surgery, the response is pretty straightforward. The appropriate coding is based upon the total number of lesions involved.


 


CPT 17110 is described as 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.


 


CPT 17111 is described as above, but substitute 15 or more lesions.


 


Michael G. Warshaw, DPM, CPC, Lady Lake, FL



 


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06/16/2017    

CODINGLINE CORNER



Query: Routine Foot Care and the *-59* Modifier


 


When billing multiple routine foot care codes (e.g., CPT 11720 and G0127), possibly with CPT 11055 (or CPT 11056 or CPT 11057), can you use a “-59” modifier on both codes, or is that not appropriate? I have heard through the grapevine that if you do, then both codes will be reimbursed at a 100% each.


 


Joseph Borreggine, DPM, Charleston, IL


 


Response: According to the Correct Coding Initiative (CCI) file, CPT 11720 is secondary to CPT 11055, CPT 11056 and CPT 11057. In order to obtain reimbursement for CPT 11720, a “-59” modifier must be appended to the CPT 11720 code assuming the nails are distinct and separate from the corns and calluses.


 


HCPCS code G0127 is secondary to CPT 11720, so the “-59” modifier would be required with the G0127 code. This also assumes the nails debrided are separate and distinct from the dystrophic nails that were trimmed. It is extremely important to document the location of all corns and calluses that are pared and cut and differentiate which nails were debrided and which nails were trimmed.


 


Robert Weatherford, CPC, Jacksonville, FL



 


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06/13/2017    

CODINGLINE CORNER


Query: Fracture Diagnosis


 


When submitting diagnosis of a fracture, do I have to have a date of injury?


 


Alex Gorenshtein, DPM, Winchester, VA


 


Response: It is not necessary to add the date of injury unless it is pertinent to the case or payer.


 


Some payers, such as Workers’ Comp may want to see the date in the notes  and even in the coding for reimbursement. It is not really mandatory to report the date of the fracture. It is a good idea, however, to properly document in your notes the date of injury and perhaps even location.


 


Mike King, DPM, Roswell, GA


 


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06/12/2017    

RESPONSES/COMMENTS (CODINGLINE CORNER)


RE: Pre-Surgical Dispensing of DME


From: Paul Kesselman, DPM


 


The main issue here is that there is no medical necessity for the DME prior to surgery (according to Medicare and other carriers). It is a great idea to dispense devices prior to medical necessity for patients to practice using the device absent the influence of narcotics, etc. It unfortunately is not a covered service under Medicare. 


 


There will be more on this topic in the September issue of Podiatry Management.


 


Paul Kesselman, DPM, Woodside, NY

06/02/2017    

CODINGLINE CORNER



Query: Wound Care Center POS Code


 


We are beginning to treat patients at a local wound care center. What location/place of service code do I use?


 


Michael Giordano, DPM, Rochester, NY


 


Response: There are 2 Place of Service (POS) codes that became effective January 1, 2016 that would apply directly to a wound care center.


 


POS 19  Off Campus – Outpatient Hospital A portion of an off – campus hospital provider based department which provides diagnostic, therapeutic (both surgical and non-surgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.


 


POS 22 On Campus – Outpatient Hospital A portion of a hospital’s main campus, which provides diagnostic, therapeutic (both surgical and non-surgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.


 


Michael G. Warshaw, DPM, CPC, Lady Lake, FL



 


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05/30/2017    

CODINGLINE CORNER



Query: Weil Metatarsal Osteotomy


 


Can I use diagnosis code, ICD-10 M77.41 (metatarsalgia, right foot) for CPT 28308?


 


Brian Buckrop, DPM, Moline, IL


 


Response: I do not suggest using M77.41. I recommend the metatarsal deformity codes:


 


M21.6X1   Other acquired deformities of right foot


M21.6X2   Other acquired deformities of left foot


 


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



 


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05/26/2017    

CODINGLINE CORNER



Query: Denials on Multiple CPT 28285 Billing


 


I am having an issue with billing CPT 28285. When we perform a hammertoe repair, we bill CPT 28285 on one line with 3 toe modifiers and 3 units. We are not getting paid. Do we need to bill each on a separate line? Other suggestions?


 


Russell Petranto, DPM, Toms River, NJ


 


Response: We bill the 3 hammertoes on 3 different lines.  For example:


 


CPT 28285-T1


CPT 28285-T2-XS (or “-59”)


CPT 28285-T3-XS (or “-59”)


 


We use “XS” for Medicare and “-59” for private insurance. Some of my colleagues will say you do not need either because the “T” modifiers are supposed to be distinct. My experience is that if you do not add them to the 2nd and subsequent procedure, they will be denied.


 


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



 


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05/23/2017    

CODINGLINE CORNER



Query: Billing L4360 Without Patient Being Seen


 


If a patient was seen by their primary care physician, and told to come to our office for a boot (L4360), how would we go about billing this to the insurance company since they weren’t seen by any of the physicians in our office?


 


Cindy Whitesides, Austin, TX


 


Response: What you can or cannot do is dependent on the payer. For example, if this is a Medicare “patient” and you are a Medicare supplier, you can dispense DME and supplies…but only to your patients. You are designated a “physician supplier”. You cannot see patients from others referred to your office specifically for the purpose of having you dispense an AFO or walking boot. If you would like to be a commercial supplier (as opposed to physician supplier), you would need to be accredited and obtain a surety bond.


 


If this is a non-Medicare “patient”, the rules regarding your ability to dispense are specific to the payer and plans. You absolutely need to qualify your ability to dispense DME and supplies not only to “patients” referred to you for the purpose of you dispensing items, but also your own patients. For example, if the plan has a contract with a local supplier, the patient may be restricted to “pick up” orthoses or supplies with a prescription. Check with the individual payer.


 


Harry Goldsmith, DPM, Cerritos, CA



 


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05/19/2017    

CODINGLINE CORNER



Query: Delayed Union Diagnosis


 


We have a patient who had a tibio-calcaneal fusion September 2016, but now has a delayed union. I cannot find an appropriate diagnosis code. I know for the delayed union, I need to describe why there is a delayed union, usually of a fracture. Any info would be greatly appreciated.


 


Jennifer Powell, Billing Specialist, Mid-South Foot & Ankle Specialists, PLLC, Memphis, TN


 


Response: When it comes to ICD-10 and surgical fusions, there are not many choices. It would never fall into the fracture category. Please see if M96.0 (pseudarthrosis after fusion or arthrodesis) will work for your doctor.


 


Otherwise, it is an other acquired deformity, and those options are for the leg as this is a “tibio-calcaneal” acquired deformity: M21.861 (other specified acquired deformities of right lower leg) or M21.862 (other specified acquired deformities of left lower leg).


 


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



 


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05/16/2017    

CODINGLINE CORNER



Query: Ultrasound Guided Injections Into Plantar Fascia


 


When administering a cortisone injection into the plantar fascia via ultrasound guidance, what is the best CPT code to use?


 


Robert Marra, DPM, Enfield, CT


 


Response: The code for ultrasound (US) guided injections is CPT 76942 (ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).


 


I recommend that your documentation be very clear as to the medical necessity for performing an US guided injection versus just palpating the area and then injecting.


 


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



 


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05/13/2017    

CODINGLINE CORNER



Query: Medicare Location Address


 


I operate a solo mobile podiatry practice in one state, and will soon expand to anther state. Does Medicare require that I maintain an operational business address in both states, or just one of the states?


 


Troy Harris, DPM, Swansboro, NC


 


Response: In my opinion, you are required to obtain a separate enrollment as your services are being provided on a regular basis in a different payment area and under different carriers. This is a bit different than house calls (which also presents its special challenges).


 


I suggest you contact an enrollment specialist to assist you with the special issues presented by this scenario.


 


Paul Kesselman, DPM, Woodside, NY



 


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05/09/2017    

CODINGLINE CORNER



Query: Coding Amputations Due to Osteomyelitis


 


I performed a 4th left toe amputation and a partial metatarsal amputation due to osteomyelitis. Which is best to code and bill for maximum payment?:


CPT 28820   toe amputation


CPT 28122   excision of metatarsal bone 


or


CPT 28005   incision, bone cortex (eg, osteomyelitis or bone abscess), foot


 


Peter Luthringer, DPM, Naples, FL


 


Response: I suggest an alternate coding scenario:


 


CPT 28122-LT


CPT 28820-59


 


The first code represents the partial amputation of the metatarsal for osteomyelitis and the second represents amputation of toe at the metatarsal-phalangeal joint. CPT 28005 has no coding relationship to your procedure performance.


 


Harry Goldsmith, DPM, Cerritos, CA



 


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05/06/2017    

CODINGLINE CORNER



Query: MIPS Without an EHR


 


I plan to retire in less than four years. My solo practice does not have electronic health records. Is there any way that I can report MIPS for 2017? We do send our claims to Medicare with an electronic computer clearinghouse.


 


PM News Subscriber


 


Response: There are three MIPS categories for 2017 - Quality, Advancing Care Information (ACI), and Clinical Practice Improvement Activities (CPIA). Only ACI requires an EHR.


 


You can fully participate and report on the Quality and CPIA categories without an EHR. Scoring perfectly in those two categories without doing anything for ACI will result in a MIPS score of 75, which is expected to result in a bonus of over 4%.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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05/02/2017    

CODINGLINE CORNER



Query: Bone Plate and Screw Placement Coding


 


I recently performed a surgery at the outpatient center whereby I did a 1st metatarsal-phalangeal joint arthrodesis.  I used a Stryker bone plate with four screws. I am looking for a procedure code for my putting in the bone plate and screws. Please tell me what procedure code (CPT) to use so I get compensated for that. I know to use the CPT 28750 code for the procedure, but there should be an additional code for me to use for the placement of the bone plate and screws.


 


Barbara Rien, DPM, Boca Raton, FL


 


Response: You have the correct CPT coding for the arthrodesis of the 1st metatarsal-phalangeal joint. That’s the good news.  The bad news is that there is no additional payment for complex fixation hardware. So whether you use two crossed K-wires or use compression plates, cancellous screws, or monofilament wire, the reimbursement for the surgery is the same. Be my guest and add a “-22” modifier indicating greater complexity than a standard procedure, but I wouldn’t hold my breath for added reimbursement.


 


Howard Zlotoff, DPM, Camp Hill, PA



 


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04/28/2017    

CODINGLINE CORNER



Query: Coding for Trauma Wound with Hematoma


 


I have an 80 year old female non-diabetic patient with normal peripheral vascular status who was cleaning her oven and bumped into the open door causing bilateral skin tears of both legs. She also had an organized hematoma of the right leg at the margins of the wound. The only code for “hematoma” that I can find states “with skin intact”. The ICD-10 Alphabetic Index then suggests to look at “Contusion” by location. Even there, I could not find a code mentioning “hematoma” that did not mention “with skin intact”. Also, these wounds are traumatic not pressure or diabetic and they are not lacerations. Am I missing something or is it just ICD-10 overload and we just take our best guess?


 


Kevin Brattain, DPM, Peoria, IL


 


Response: I recommend looking at “laceration” ICD-10 coding. You said “bilateral skin tears of both legs. She also had an organized hematoma of the right leg.” So it seems this was the initial encounter for the acute episode of care and you would select for both legs:


S81.811A  laceration without foreign body, right lower leg


S81.812A  laceration without foreign body, left lower leg


 


Additionally, you stated this is a hematoma which is the same as a contusion.


S80.11xA  contusion of right lower leg


 


You are using injury codes, so make sure you document the date she injured her legs.  It would be called the date of injury in your billing software.


 


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



 


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04/25/2017    

CODINGLINE CORNER


Query: CPT 17110 Denials


 


Does anyone know why Medicare in Pennsylvania has stopped paying (“non-covered”) for 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 to14 lesions) for the treatment of plantar warts?


 


Edwin S. Hart, DPM, Bethlehem, PA


 


Response: Try coding it using a primary diagnosis of wart (B07.0) and a secondary diagnosis of pain, such as


 


M79.671   pain in right foot


M79.672   pain in left foot


M79.674   pain in right toe(s)


M79.675   pain in left toe(s)


 


Jeffrey D Lehrman, DPM, Springfield, PA


 


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04/21/2017    

CODINGLINE CORNER



Query: ICD-10 Coding: Enlarged and Hypertrophic Nails


 


I am having a problem locating the appropriate ICD-10 code for an enlarged and hypertrophic nail to be used with the debridement of the nails, CPT 11720 and CPT 11721 codes. My code search takes me to Q84.5 (enlarged and hypertrophic nails; congenital), but most of the nail thicknesses seen are acquired. What ICD-10 code should we be using to describe acquired enlarged and hypertrophic nails in a diabetic patient?


 


Deb Lewis, CPC, Colorado Springs, CO


 


Response: Noridian is my Medicare contractor. I use ICD-10 L60.2 (onychogryphosis) to describe enlarged and hypertrophic nails.


 


Tony Poggio, Alameda, CA



 


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04/18/2017    

CODINGLINE CORNER



Query: Penalties for Using CR vs DR X-Ray Systems


 


Is there a penalty in 2017 for using a CR rather than a DR x-ray system? I was led to believe that there would be a downward payment adjustment for not upgrading our old ScanX to a direct digital system.


 


Wendy Siegel, DPM, Smithtown, NY


 


Response: Medicare/CMS as of January 1, 2017 began reducing payments to providers submitting claims for analog x-ray studies by 20%. The reduction is deducted from the “Technical Component” of the x-ray service.


 


Starting in 2018, payments for x-ray studies performed using computed radiography (CR) equipment will be reduced by 7% for the next five years and 10% after that. The goal is for all x-ray studies to be performed using digital radiography (DR).


 


Michael G. Warshaw, DPM, CPC, Lady Lake, FL



 


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04/15/2017    

CODINGLINE CORNER



Query: The Use of CPT 20500


 


Is CPT 20500 (injection of sinus tract; therapeutic [separate procedure]) only to be used if dealing with a sinus tract, or can it be used as a therapeutic injection for other pathology?


 


Barry Feinstein, DPM, North Hollywood, CA


 


Response: I think the use of CPT 20500 is limited to injection of a sinus tract. If you inject something other than a sinus tract, you should code the injection procedure specific to the type of injection performed.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


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04/11/2017    

CODINGLINE CORNER


Query: In-Hospital Patient Consultations


 


I am unclear as to what code to use for an inpatient hospital initial consultation. I have been denied by my Medicare Part B contractor on CPT 99222 (initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; and medical decision-making of moderate complexity), stating only an admitting physician can use that code. So, then I tried CPT 99252 (initial inpatient consultation for a new or established patient), and it was denied stating that code was invalid.


 


Vanessa Sloan, Effingham, IL


 


Response: Medicare eliminated “consultation” codes so, yes, those are invalid. You are allowed to use the initial hospital care codes, if, as you say, you meet the code’s requirements. These codes for Medicare are not exclusive to the admitting doctor. Your Medicare contractor denied you incorrectly.


 


You may want to call and ask for a supervisor. If you get the same information, I would then notify your state association and bring this to their attention. Get the reference number of the call you made as that can be used to track down what happened.


 


Tony Poggio, DPM, Alameda, CA


 


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04/07/2017    

CODINGLINE CORNER


Query: MIPS: Registry vs. Claims Made Basis


 


After listening to a number of webinars, our group practice would like to report via a registry for the former PQRS measures. In past years, we have always done this on a claims made basis. Since our EMR was already set up this way, all providers have been answering the questions in 2017, and sending them on claims as before. Does this action mean we are forced to continue claims made submission for the coming year? If so, I will make sure this doesn’t happen in 2018.


 


Jane Graebner, DPM, Delaware, OH


 


Response: My understanding is that you can switch over to registry reporting for 2017 even though your providers have been submitting via claims so far.


 


I think when the registry reports your quality data that will trump the claims that have been submitted. I also think we are going to be given the opportunity to designate our reporting period and you can choose your reporting period for your Quality category to be during the time you were using the registry.


 


Jeffrey D Lehrman, DPM, Springfield, PA


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04/03/2017    

CODINGLINE CORNER


Query: Place of Service Injection Denial


 


I injected a patient for her plantar fasciitis during a home visit. She has Blue Cross/Blue Shield. She herself is not homebound, but due to having a number of children, it makes it easier for me to do this at her home. It is admittedly a convenience. I did not bill an office visit, just the plantar fascial injection. It was denied due to place of service. It there any way to appeal this?


 


Jeffrey B Klein, DPM, Waterford, MI


 


Response: You can always appeal, Whether you win or not is another question.


 


You should ask if there is a difference in reimbursement for that injection based upon the site of service. If there is not, then you can argue that the injection was medically necessary, there is no added cost to the carrier and, therefore, it should be paid.


 


Tony Poggio, DPM, Alameda, CA


 


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03/31/2017    

CODINGLINE CORNER


Query: Coding for Plantarflexed Metatarsal



 


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


 


Adam Klein, DPM  Lynbrook, NY


 


Response: CPT 20550 is defined as “injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar fascia)”. Your post did not state that you injected either a tendon sheath or ligament.


 


CPT 20600, on the other hand, is defined as “arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes); without ultrasound guidance” which appears to meet your coding needs.


 


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



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ASPMA