Spacer
PMbanA7-513.jpg
Spacer
PresentBannerCU1117
Spacer
INGBannerE215
Podiatry Management Online


Facebook

Podiatry Management Online
Podiatry Management Online


PMBannerG9_513

Search

 
Search Results Details
Back To List Of Search Results

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


Codingline subscription information can be found at:

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


Other messages in this thread:


01/16/2018    

CODINGLINE CORNER



Query: Lesser Metatarsal Joint Implant


 


One of our doctors performed outpatient surgery on a patient for two procedures. One was CPT 28299 (bunionectomy with double osteotomy) for M20.12 (hallux valgus [acquired], left foot).  The other was a lesser metatarsal joint implant for M19.172 (post-traumatic osteoarthritis, left ankle and foot). The code we are thinking of using for the lesser metatarsal implant procedure is CPT 28899 (unlisted foot/toe procedure).  Are there any better choices?


 


Office of Mary Gail Kwiecinki, DPM, Libertyville, IL


 


Response: Unfortunately, there is not a CPT code that describes placing an implant into a lesser metatarsophalangeal joint to correct a situation such as M19.172 (post-traumatic osteoarthritis, left ankle and foot). It would probably be best to use CPT 28899 (unlisted procedure, foot or toes). I recommend submitting the claim hard copy on a CMS-1500 claim form accompanied by the operative report which accurately describes the procedure that was performed. I also believe that it would be in one’s best interest to pre-certify the procedure with the insurance carrier to make sure that the procedure being performed is not classified as “experimental” or categorized in some fashion that would pre-empt reimbursement.


 


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



 


For information on Codingline subscriptions, click here

01/15/2018    

RESPONSES/COMMENTS (CODINGLINE CORNER)


RE: Modifier for CR Imaging (Jeffrey D Lehrman, DPM)


From: David J. Freedman, DPM, Michael Tritto, DPM


 


Dr. Lehrman’s post was not completely correct. Here is an update. I contacted Novitas to see what was the best recommended billing for the FY modifier. While you can break the billing down into the PC/26 option, as Jeff related for x-rays with CR imaging, they recommended straight one line billing. The example for a podiatrist to bill for an x-ray with CR imaging is: 73630-RT-FY.


 


David J. Freedman, DPM, Silver Spring, MD


 


I would like to add a comment about billing for x-rays with the FY modifier. Most of us bill x-rays globally, meaning we bill on one line. This indicates we are billing for both the technical component (TC) and the professional component (PC). The CMS guidance to carriers, as well as the information our group has received from our carrier Novitas, confirms that we can continue to bill on one line (globally) and just add the FY modifier. The carrier will reduce the fee by 7% of ONLY the TC part, not the entire value of the code. They are required to do this for globally billed codes per CMS. While billing on two lines and breaking out the TC and PC will likely still be paid, it is unnecessary.


 


Michael Tritto, DPM, Rockville, MD 

01/12/2018    

CODINGLINE CORNER



Query: Modifier for CR Imaging


 


Since our office is still using a CR imaging system, what is the appropriate modifier we are to bill with to Medicare? The “FX” modifier seems to apply to film x-ray. Also, based on what I have read so far, the penalty is only on the technical component. Since we normally bill for both the technical and professional components (all in one, no modifiers except for the “RT” and “LT”), do we now need to break down charge and bill separately for the technical and professional components with “TC” and “PC” modifiers?


 


Coleen Merrill, Office Administrator, Office of Evan Merrill, DPM, Medford, OR


 


Response: CMS now requires appending the “FY” modifier to claims for the technical component of a digital x-ray that employs a CR-specific cassette (utilizing an imaging plate to create the image) in place of a traditional film cassette. This “FY” modifier will result in a 7 percent reduction to the technical component (and the technical component of the global fee). This reduction is expected to last until 2023, when the reduction is slated to increase to 10 percent.


 


I suggest “breaking it down” as you described with the same code on two lines, one with a “26” (not a “PC”) professional component modifier (assuming those requirements are met) and the other with both “TC” and “FY” modifiers.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


For information on Codingline subscriptions, click here

01/09/2018    

CODINGLINE CORNER



Query: CPT 64450 + ICD-10 G57.3- Denials


 


CPT 64450 (injection, anesthetic agent; other peripheral nerve or branch) when billed with ICD-10 G57.31 or G57.32 (lesion of lateral popliteal nerve, right lower limb or left lower limb, respectively) is now (as of October 1) being denied by Blue Cross Blue Shield and Medicare (Novitas) as “investigational and not medically necessary”. The only LCD I was able to locate is L35107 which has been superseded or retired. I am not finding an active LCD. Is anyone getting this paid? What am I doing wrong?


 


Emilie Arambula, CPC, Colorado Springs, CO


 


Response: In Colorado, your MAC is Novitas. They just retired the LCD for “Pain Management of Peripheral Nerves by Injection” (L35107) on December 1, 2017.  CPT 64450 is included in that retired LCD.


 


When an LCD is retired, it does not automatically mean that CPT codes discussed in that LCD will no longer be payed. However, in this case, based on what we have been hearing, the retirement of Novitas LCD, L35107, has coincided with denial of payment for CPT 64450 and CPT 64455.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


For information on Codingline subscriptions, click here

01/05/2018    

CODINGLINE CORNER



Query: Medicare Physical Therapy Denial 


 


I am trying to get CPT 97022-GP (application of a modality to one or more areas; whirlpool; services delivered under an outpatient physical therapy plan of care) paid by Medicare. It has been denied. Do I need to add a second modifier? The diagnosis codes billed include M79.673 (pain in unspecified foot) or M79.676 (pain in unspecified toes).


 


PM News Subscriber


 


Response: I suggest that it may be the ICD-10 diagnoses codes and other issues instead of the procedure code or modifiers that is your denial problem. Saying that the pain is in an unspecified foot or toe indicates to the insurance company that the medical records for the patient are incomplete in that that record does not state which foot or toe is involved. Every insurance company when given the opportunity has opted not to pay for unspecified codes when there is a diagnosis code with laterality available.


 


Second, most insurance companies have policies or in the case of Medicare an LCD in place for physical therapy modalities. Those policies and LCDs typically set forth the diagnoses under which the various modalities will be paid. Have you checked to see that there is coverage for foot or toe pain? If not, you might need to establish a more succinct diagnosis for your patient.


 


Paul Kinberg, DPM, Dallas, TX



 


For information on Codingline subscriptions, click here

01/02/2018    

CODINGLINE CORNER



Query: Billing Bilateral Bunionectomies


 


I performed bilateral bunionectomies with osteotomy, and billed : CPT 28296-TA


CPT 28296-T5 and was denied by Medicare. What am I doing wrong?


 


Codingline Archive Question


 


Response: CPT 28296 accepts bilateral billing for Medicare, so I suggest that you bill it with the “50” modifier appended.


 


You would bill CPT 28296-50, one unit, and double (or whatever you feel is appropriate) the price. It should then pay at 1.5 times the base fee schedule allowed.


 


Katherine Sharp, Keystone Professional Solutions, Woodbury, TN



 


For information on Codingline subscriptions, click here

12/26/2017    

CODINGLINE CORNER



Query: Split-Thickness Skin Graft


 


Can CPT 15002 (surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar or incisional release of scar contracture, trunk, arms, legs: first 100 sq cm) be used for wound prep when performing a split-thickness skin graft (STSG), or is this just a scar tissue release code?


 


Michael Downey, DPM, Fort Worth, TX


 


Response: In my opinion, CPT 15002 can be used for wound prep when preparing a site to receive split thickness skin graft.


 


CPT says these codes are for “services related to preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy”.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


For information on Codingline subscriptions, click here

12/23/2017    

CODINGLINE CORNER



Query: CPT 64450 + ICD-10 G57.3- Denials


 


CPT 64450 (injection, anesthetic agent; other peripheral nerve or branch) when billed with ICD-10 G57.31 or G57.32 (lesion of lateral popliteal nerve, right lower limb or left lower limb, respectively) is now (as of October 1) being denied by Blue Cross Blue Shield and Medicare (Novitas) as “investigational and not medically necessary”. The only LCD I was able to locate is L35107 which has been superseded or retired.  I am not finding an active LCD.


Is anyone getting this paid? What am I doing wrong?


 


Emilie Arambula, CPC, Office of Deb Lewis, CPC; COS Op Mgr, Colorado Springs, CO


 


Response: In Colorado, your MAC is Novitas. They just retired the LCD for “Pain Management of Peripheral Nerves by Injection” (L35107) on December 1, 2017.  CPT 64450 is included in that retired LCD.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


For information on Codingline subscriptions, click here

12/19/2017    

CODINGLINE CORNER



Query: 2018 MIPS Quality Measures


 


Have the 2018 quality measures for MIPS been finalized and/or published yet? I have done extensive searching online, but can only come up with 2017 measures. If they haven’t been finalized yet, when will they be available? Where would be a good place to find them?


 


Lisa M. Karpelman, Practice Administrator, Office of Herbert Karpelman, DPM, Cheshire, CT


 


Response: Yes, the 2018 MIPS Quality Measures have been finalized. While the measures themselves have not changed from 2017 to 2018, there have been some changes to this category:


 


1) Quality will now counts for 50% of your overall MIPS Composite score.


2) Data Completeness for measures will now be 60%.


3) The performance threshold has been raised to 15 points from 3 points.


4) The reporting period has changed from a minimum of 3 months to a full calendar year.


 


Alan Bass, DPM, Manalapan, NJ



 


For information on Codingline subscriptions, click here

12/15/2017    

CODINGLINE CORNER



Query: Mass Excised Within the Tarsal Tunnel


 


What codes would you recommend for an excision of a large benign Schwannoma within the tarsal tunnel? The tarsal tunnel was decompressed with excision of the soft tissue mass which measured approximately 3 cm by 3 cm x 2 cm.


 


Jeffrey Klein, DPM, Waterford, MI


 


Response: I suggest CPT 64788 (excision of neurofibroma or neurolemmoma; cutaneous nerve). If the tarsal tunnel decompression was performed as part of the dissection to get to the schwannoma (which it sounds like it was), I do not think it should be separately coded.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


For information on Codingline subscriptions, click here

12/12/2017    

CODINGLINE CORNER



Query: Toe Fillers & Custom Diabetic Insoles


 


I was doing a follow-up with a patient whom I sent to Hanger for custom diabetic insoles and a hallux toe filler on the left orthotic.  When I asked the patient if they got the three pairs of insoles (to be replaced quarterly), they told me no, they only got one pair. I called Hanger to ask why that was and they informed me that under the new Medicare guidelines, “toe fillers” on orthotics makes them technically a prosthetic and Medicare will only pay for one pair a year.


 


Anthony Hoffman, DPM, Oakland, CA


 


Response: Hanger is correct. Medicare will cover only one L5000 code as it is considered a prosthetic. If you, however, ordered custom insoles for one foot and the toe filler for the other, Medicare will pay for three of the custom inserts. We bill this scenario as:


 


A5500-KX-RT-LT   2 units


L5000-KX-LT  1 unit


A5513-KX-RT   3 units


 


The good news about the toe filler being considered a prosthetic is that if you order shoes and inserts for a patient who then has an amputation, the prosthetic can be filled outside the normal restrictions of one pair of shoes and three pairs of inserts per year.


 


Katherine Sharp, Keystone Professional Solutions, Woodbury, TN



 


For information on Codingline subscriptions, click here

12/08/2017    

CODINGLINE CORNER



Query: Patient Seen in Office While Residing in SNF


 


We have a patient who was seen in the office for a post-operative visit. The patient had resided in a skilled nursing facility (SNF) for two weeks at the time of the visit. His wife brought him to the visit. We took an x-ray in the office, billed Novitis Medicare, CPT 73630 (1 unit). Medicare is saying they overpaid the claim and want to take back what they paid. The reason given: “Services within a Skilled Nursing Facility are subject to consolidated billing”.


 


The representative is telling me we have to bill the nursing facility, they bill Medicare and then pay us. She cites the 2017 CMS site for guidelines on Consolidated Billing. CPT 73630 is not on this list of procedures that can be billed by the doctor’s office. This just doesn’t make sense. Has anyone else run into this?


 


Peter Cuesta, DPM. Ocean Pines, MD


 


Response: The rep was only partially right. They inappropriately only overpaid you for the technical portion of the x-ray study allowance. X-ray studies (the technical component) fall under Consolidated Billing, but you can bill and get paid for the x-ray study professional component from your Medicare Part B contractor (Novitas) by applying a “26” to the x-ray code.


 


The skilled nursing facility (SNF) is paid in a lump sum for services such as the x-ray study technical component. If you have a prior arrangement with the SNF, you may get paid directly by the SNF for the technical component. If you haven’t set-up an agreement with the SNF, contact their administration. The worst that can happen is that you won’t get that portion of the study…but you’ll know for the future.


 



Tony Poggio, DPM, Alameda, CA


 


For information on Codingline subscriptions, click here

12/05/2017    

CODINGLINE CORNER



Query: Diagnosing a Failed Fusion


 


What diagnosis do you bill when performing CPT 28755 (arthrodesis great toe; interphalangeal joint) for a failed IP fusion, left hallux?


 


Charles Chapel, DPM, Brooksville, FL


 


Response: I see these two options for your diagnosis decision:


 


M96.0  Pseudarthrosis after fusion or arthrodesis


 


M96.89 Other intraoperative and post-procedural complications and disorders of the musculoskeletal system


 


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



 


For information on Codingline subscriptions, click here

12/01/2017    

CODINGLINE CORNER



Query: CPT 11730 Denials


 


I have denials from Horizon Blue Cross Blue Shield of NewJersey for the following code combination: CPT 11730-TA (nail avulsion, left hallux) L60.03,  L03.032 (cellulitis, left toe), and M79.675 (pain, left toe). They are saying that the problem is with the L60.03 code. Is this correct?


 


William Kelley, DPM, Ramsey, NJ


 


Response: The correct code is L60.0. It is a 4-digit code and needs no other numerals appended to it. There is no problem with you reporting the M79.675 if it is required by the insurance company, but it should not be necessary.


 


In the future, I  suggest you check your coding with a source. I recommend the APMA Coding Resource Center so you can be sure you are filing the correct codes with all the necessary digits and 7th character extension. The APMA CRC has a unique way, with a red box that has a number and a plus sign in it to let you know how many alpha and numeric characters are needed for each code in ICD-10. And for the 7th character, it gives you the possible choices.


 


Paul Kinberg, DPM, Dallas, TX



 


For information on Codingline subscriptions, click here

11/28/2017    

CODINGLINE CORNER



Query: Billing Bilateral CPT 11730 and Bilateral CPT 11750


 


Suddenly, we are getting denials for procedure code, CPT 11730 and CPT 11750 when billed for bilateral toes. We have always billed, for example, CPT 11730-TA and CPT 11730-T5, but now the second procedure is being denied. We have tried adding the “59” modifier, but it does not help. They are saying it is a “units issue”, but we bill one unit for each procedure. Any ideas?


 


Shannon McFeaters, DPM, Pittsburgh, PA


 


Response: If performing CPT 11750 on a right hallux and CPT 11730 on a left hallux, I suggest that be coded as:


 


CPT 11750-T5


CPT 11730-59-TA


 


If performing CPT 11730 on bilateral hallux nails, I suggest that be coded as:


 


CPT 11730-TA


CPT 11732-T5


 


CPT 11732 is “avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure) (add-on code)”.  Because it is an add-on code, no “59” modifier is necessary.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


For information on Codingline subscriptions, click here

11/25/2017    

CODINGLINE CORNER



Query: CPT 15275 and CPT 97597 Together


 


Can you bill CPT 15275 (application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area) and CPT 97597 (selective debridement) together for the same area?


 


Also, if one CPT code is a Column 1 and the other is Column 2 of the CCI edits, are you allowed to bill them together?


 


Benjamin McKinney, DPM, Reidsville, NC


 


Response: There is a CCI edit between CPT 15275 and CPT 97597. Therefore, you should not bill for both if they are performed for the same ulcer at the same visit.


 


If one CPT code is Column 1 and the other is Column 2, you should not bill them together if they are being performed for the same pathology at the same location. For the most part, they should not be billed together unless one of them meets the requirements of the “25” (E/M) modifier or “59” (procedure) modifier.


 


Jeffrey D Lehrman, DPM, Springfield, PA



 


For information on Codingline subscriptions, click here

11/21/2017    

CODINGLINE CORNER



Query: Patient Seen in Office While Residing in SNF


 


We have a patient who was seen in the office for a post-operative visit. The patient had resided in a skilled nursing facility (SNF) for two weeks at the time of the visit. His wife brought him to the visit. We took an x-ray in the office, billed Novitis Medicare, CPT 73630 (1 unit). Medicare is saying they overpaid the claim and want to take back what they paid. The reason given: “Services within a Skilled Nursing Facility are subject to consolidated billing”. The representative is telling me we have to bill the nursing facility, they bill Medicare and then pay us. She cites the 2017 CMS site for guidelines on Consolidated Billing. CPT 73630 is not on this list of procedures that can be billed by the doctor’s office. This just doesn’t make sense. Has anyone else run into this?


 


Peter Cuesta, DPM, Ocean Pines, MD


 


Response: The rep was only partially right. They inappropriately only overpaid you for the technical portion of the x-ray study allowed. X-ray studies (the technical component) fall under Consolidated Billing, but you can bill and get paid for the x-ray study professional component to your Medicare Part B contractor (Novitas) by applying a “26” to the x-ray code.


 


The skilled nursing facility (SNF) is paid in a lump sum for services such as the x-ray study technical component. If you have a prior arrangement with the SNF, you may get paid directly by the SNF for the technical component. If you haven’t set up an agreement with the SNF, contact their administration. The worst that can happen is that you won’t get that portion of the study…but you’ll know for the future.



 


Tony Poggio, DPM, Alameda, CA


 


For information on Codingline subscriptions, click here

11/18/2017    

CODINGLINE CORNER


Query: Billing Excision of a Heel Neuroma



What is the correct way to bill for the excision of heel neuroma?



K. Kyle Ballew, DPM, Waco, TX



Response: Since this is not a “Morton’s neuroma” (forefoot), CPT 28080 does not apply. I recommend using the more generic code, CPT 64782 (excision of neuroma, hand or foot, except digital nerve). This would be appropriate for the procedure you have described.



Howard Zlotoff, DPM, Camp Hill, PA


 


For information on Codingline subscriptions, click here

11/14/2017    

CODINGLINE CORNER



Query: Billing Bilat CPT 64455 Injections


 


My practice is having problems billing bilateral neuroma injections, CPT  64455. Claims either pay the first injection and deny the second injection, or they deny for the diagnosis codes, 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). One of my staff chatted online with a local insurance company, and they were told these “G” ICD-10 codes are going to be deleted. What diagnoses code(s) should we be using, and how do we get paid for bilateral injections. We have coded the injections as CPT 64455-50 (2 units).


 


Shannon McFeaters, DPM, Pittsburgh, PA


 


Response: I believe the problem you are having is related to the terminology of the code itself. The code reads: "Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (e.g., Morton’s neuroma)". That pesky (s) is interpreted to mean that you can bill CPT 64455 only once, even for multiple injections. No modifiers appear to work to break this understanding on the same foot.  We use the ICD-10 code for Morton’s neuroma, G57.6_ and it pays for the one unit.


 


I would also like to point out that when you are injecting two feet, use the “50” modifier, you bill for one unit and increase the price over a single injection. That is the correct protocol for that scenario. The modifier indicates that two injections are given bilaterally (150%), but don’t forget to increase what you normally charge for a single injection.


 


Katherine Sharp, Keystone Professional Solutions, Woodbury, TN



 


For information on Codingline subscriptions, click here

11/07/2017    

CODINGLINE CORNER



Query: Wound Care: SNF or Not?


 


I sometimes see patients from nursing homes at a wound care center. If the patient comes from a skilled nursing home and I bill CPT 97597, I understand that Medicare is not responsible for payment; that I should bill the nursing home. However, in the last month or so when I bill the nursing home, the nursing home states that the patient was not in a skilled bed at the time of service. Most of these have been billed to the nursing home after Medicare has sent a take-back request for payment for these dates. So Medicare sends a take back saying the patient was in a skilled bed and the nursing home states that the patient was not in a skilled bed at the time of service. What am I not understanding? 


 


Martin Lesnak, DPM, Huron, OH


 


Response: You are correct in your understanding regarding skilled nursing facility services that fall under Consolidated Billing, involving codes like CPT 97597. The nursing home is paid by Medicare Part A for those services. And you are not. You cannot bill CGS Medicare Part B. You could try to bill the nursing home for your selective debridement services, but unless you have a prior arrangement with the nursing home, the most you may get is a “thank you for your service; no, we are not obligated to pay you.”


 


The question you posed that needs to be resolved is the status of the bed in which the patient resided on the day you performed the selective debridement service. You should go to the nursing home business office, and have them pull the accounting/business records on the patient. If the patient was not in a skilled nursing facility bed at the time of service, copy the records and ask the head of the business office or administrator of the nursing home to write a short note to that effect. Send the copy of the patient’s status and the note, along with a request for reconsideration and a letter of explanation, to CGS Medicare Part B.


 


If, however, the records show the patient was a skilled nursing facility patient at the time of your services, you have to sit down and let the nursing home administrator know, and see if you can get them to retroactively reimburse you for your services, given the confusion. It might be a longshot, but you never know.


 


Harry Goldsmith, DPM, Omaha, NE



 


For information on Codingline subscriptions, click here

11/03/2017    

CODINGLINE CORNER



Query: ICD-10 and CPT Coding for Right Foot Surgery


 


What are the best ICD-10 and CPT codes for the following surgery performed on the right foot?


–  Revision of a scar (8 cm long, causing severe contraction of the first MPJ);


–  Releasing the involved extensor hallucis longus tendon and repairing it; and


–  Excising the plantar prominent first metatarsal head


 


Rajesh Daulat, DPM, Glendale, AZ


 


Response: The CPT Manual says for scar revision to use a complex repair code such as CPT 13100-13102 with L91.0 for hypertrophic scar.


 


For the contracture release of the extensor hallucis longus tendon, I suggest CPT 28270 with ICD-10 code M20.5X1 (toe deformity), and for the plantar condylectomy of the first met head, I would use CPT 28122 with ICD-10 code M25.774 for exostosis.


 


Joseph Borreggine, DPM, Charleston, IL



 


For information on Codingline subscriptions, click here

10/31/2017    

CODINGLINE CORNER



Query: Toe Fracture Fragment with Soft Tissue Mass Excision


 


My patient had the tip of the distal phalanx in the left 4th toe broken off and displaced. The fragment has tipped over laterally and a soft tissue mass has developed at the tip. The mass keeps getting infected superficially due to the pressure. So, if the fragment and soft tissue mass are excised, should I bill for both or is the mass excision incident to the fracture fragment excision?


 


Mike King, DPM, Roswell, GA


 


Response: I feel that the best procedure code to bill for this scenario would be CPT 28124  Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (e.g., osteomyelitis or bossing); phalanx of toe. This appears to be the CPT code with the best description of what needs to be performed.


 


As far as the “soft tissue mass” is concerned, since the osseous fragment is directly related to the soft tissue mass and both the fragment and the mass are going to be excised, this is a “BOGO” so to speak and the excision of the fragment is billable, but not the excision of the mass. It would be considered to be incidental.


 


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



 


For information on Codingline subscriptions, click here

10/28/2017    

CODINGLINE CORNER



Query: Gout Injection Coding


 


A Medicare patient presented with gout symptoms in the foot. I gave an injection of lidocaine, Marcaine, and a small amount of dexamethasone proximal to the gout-symptomatic area for the hyperemic effect. How can I bill the injection?


 


Adam Klein, DPM, Lynbrook, NY


 


Response: The choice of injection codes would be based primarily on the location of the injection. For example, CPT 20550 for the injection of “single tendon sheath, or ligament, aponeurosis“.


 


If you injected a joint, e.g., metatarsal-phalangeal joint or interphalangeal joint, the coding might by CPT 20600 (arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes); without ultrasound guidance).


 


You can also bill the “J” code for appropriate amount and type of dexamethasone you used.


 


Mike King, DPM. Roswell, GA



 


For information on Codingline subscriptions, click here

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



 


For information on Codingline subscriptions, click here

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



 


For information on Codingline subscriptions, click here