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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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02/28/2015    

CODINGLINE CORNER


Query: Modifier -25 vs -57 Use


 


If you have a new patient who presents with pain in a toe, you examine the patient to find out he/she has a paronychia. You decide to perform a nail surgery at the same time of the initial visit. Should one use new office visit with modifier "-25" or "-57" with pain in foot as the diagnosis and then CPT 11730 or CPT 11750 with the paronychia diagnosis along with the location? This question comes up in order to determine if the insurance company will pay for the initial visit in addition to the surgery. 


 


David Hamilos, DPM, Johnson City, TN


 


Response: These modifiers both alert the payer that the E/M service performed was significant and separately identifiable and not included in the surgical service allowance. The distinction between these two modifiers is that the "-25" modifier is used to amend the E/M code only when the surgical procedure has a 0 or 10 day global. The "-57" modifier is used to amend the E/M code when the surgical procedure has a 90-day global and a decision for surgery was made through the E/M service for a procedure that will be performed within 24 hours. 


 


Paul Kesselman, DPM, Woodside, NY


 



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02/26/2015    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1B



From: Michael M. Rosenblatt, DPM


 


I must respectfully disagree with Dr. Richard Rettig, regarding his advice to a DPM who was "saddled" with a Medicare deductible because an internist waited to turn in his billing, but directly billed the patient, who (allegedly) paid at time of that treatment. (Dr. Rettig suggested that the DPM contact the MD to "work out" the payment issue.) 



 


This is actually a fairly common occurrence. Most physicians wait to turn in their Medicare billings, hoping that someone else will absorb the deductible. So, even if you wait, there is still a good chance that...


 


Editor's note: Dr. Rosenblatt's extended-length letter can be read here. 


02/25/2015    

CODINGLINE CORNER


Query: Patients and Medicare Deductibles


 


A new patient was evaluated and treated for plantar fasciitis. She informed my front office that she had gone to her internist 10 days before and paid him $147 dollars, meeting her annual Medicare deductible. I billed Medicare for a new patient visit and a strapping. About one week later, I got an EOB from Medicare stating that the patient did not meet her deductible and is responsible for $105. She has no Medicare supplement. Obviously, the internist did not submit his claim until after I did, so I got stuck being owed the deductible. My question is, how do other offices handle this situation? Any advice would be greatly appreciated. 


 


Ronald Oberman, DPM, Deerfield Beach, FL


 


Response: One solution is to call the internists office, explain the situation, and try to work it out either between you two, or facilitating the overcharge refund to the patient, then getting it from the patient. That is the cleanest way to patch this up. 


 


A second way is to have the patient call 1-800-Medicare in your office, and clearing it up with your input if necessary. Since you say you have a lot of problems with this, then I suggest that you avoid this in the future, either for specific patients or across the board, by holding your claims until other doctors eat the deductible for you. 


 


Richard Rettig, DPM, Philadelphia, PA 


 



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02/21/2015    

CODINGLINE CORNER


RE: Billing CPT 96372 By a Podiatrist


 


Are there any circumstances/medications etc. when a podiatrist can bill for CPT 96372 (therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). If so, what would be the circumstances (i.e., when would it be appropriate, what medications, etc.)? Is it allowable by Medicare and/or commercial payers to bill the code in addition to other CPT injection codes or, conversely, when the code not be billed with/bundled to other injection codes or medications? 


 


Terry Boykoff, DPM, Santa Monica, CA


 


Response: I don't know of any podiatrists who administer IM injections of antibiotics within their offices. However, I could easily foresee injection of tetanus toxoid or antitoxin as long as it is within the state scope of practice. You can bill any payer for the injection administration, as well as the therapeutic supply 


 


Rick Horsman, DPM, Olympia, WA 


 



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02/18/2015    

CODINGLINE CORNER


Query: PQRS #317: Screening for High Blood Pressure


 


Patients 18 years and older are considered "not eligible" for this measure if they have an active diagnosis of hypertension. So, if a patient has a diagnosis of hypertension AND has a pre-hypertensive or hypertensive blood pressure reading (systolic > or = 120 OR diastolic > or = 80) at their visit, they would be coded as G8951 ("pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up NOT documented, patient NOT eligible"). But if the patient has a diagnosis of hypertension and their blood pressure is controlled on medication resulting in a normal blood pressure (systolic <120 AND diastolic <80), which code would be used: G8783: "Normal blood pressure reading documented, follow-up NOT required" or G8784: "Blood pressure reading NOT documented, patient NOT eligible"? 


 


Nancy Hayata, DPM, Huntington Beach, CA


 


Response: If a patient has an active diagnosis of hypertension, you report the G8784 no matter what their blood pressure reading is when taken. Technically, you do not have to take their blood pressure since this is a screening for high blood pressure measure, but for good medical care, it makes sense to take their blood pressure if they have an active diagnosis of hypertension and advise them to follow up with the provider treating their blood pressure if it is elevated. Either way, you report G8784 and this is excluded from calculating your performance on the measure but meets the reporting requirement. 


 


Jim Christina, DPM, Bethesda, MD 


 



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02/14/2015    

CODINGLINE CORNER


Query: CAM Walker and Night Splint Coding


 


Our DME vendor tells us that the “new” HCPCS code we should use for CAM walking boots is L4361, and L4397 for night splints. These new codes describe pre-fabricated devices with minimal adjustments. The codes we previously used were L4360 for CAM walking boots and L4396 for night splints. These are now described as “pre-fabricated devices that require substantial modification by a certified orthotist or an individual with equivalent expertise.” We are looking for feedback from others as to how they are now billing for these DME products. 


 


Kelly Bruce, Kingston, NY


 


Response: In 2014, CMS initiated many HCPCS changes which, as usual, created lots of confusion for orthotics and prosthetic providers. Instead of adding new codes with new definitions, CMS created new HCPCS codes using the existing definitions and also provided new definitions to existing codes. The key to your (and others' queries on this) is to look at the last portion of the definition and decide: 


 


1) What CMS meant by substantial modification and did you do so? 


2) Are you an individual with the expertise required to make the substantial modification? 


 


A DPM should be able to meet the qualifications to substantially modify (devices). And one would need to document what was done and why an OTS (off-the-shelf) device was inappropriate. "Substantially modify" is not implied by simply adjusting a strap or adding a Velcro pad from a package to the strap or boot. The new codes are appropriate for most CAM boots and night braces


 


Paul Kesselman, DPM, Woodside, NY 


 



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02/11/2015    

CODINGLINE CORNER


Query: Digital Block for Corn Debridement


 


A patient presented to the office with a painful dorsolateral corn on her right 5th digit. I attempted to debride it, however, it was so tender, she required a digital block prior to debridement. I was considering using CPT 64450 (injection anesthetic agent, other peripheral nerve or branch), but when reviewing the Medicare LCD, I didn't find an appropriate ICD-9 code to justify the injection. 


 


Jay Seidel, DPM, Baltimore, MD


 


Response: Performance of a procedure (e.g., CPT 11055) that usually does not require local anesthesia in rare cases, like you stated, may require administration of local anesthesia. In those relatively rare cases, the anesthesia would be included in the procedure. I do not recommend billing the injection as CPT 64450. 


 


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


 



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02/10/2015    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Carla Poma


 


You have been given good advice to contact your Medicare carrier and find out when claims were submitted and if they are pending, rejected, or on the payment floor. Two months (delay) hints to bigger issues beginning with the billing service. Ask your office how often they are submitting claims for billing. Are you getting paid on claims other than Medicare? Ask for reports from your billing service, and/or schedule a conference to go over your billing and look at your outstanding claims report. Doctors need to be proactive with their billing nowadays more than ever and know what is going on with their practice. Time is of the essence. 


 


Carla-Ruth Poma, Michigan Medical Billing Specialists,LLC

02/09/2015    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: John Scholl, DPM


 


With traditional Medicare (not Medicare replacement policies or Medicare HMOs), the vast majority of the patients you are seeing this year have yet to meet their Medicare deductible. Medicare must process the claims and then send the claims to the secondary insurance, which takes time. You should be getting paid little by little from the secondary insurance companies until the patients meet their deductible. When deductibles are met, you should start receiving the Medicare payments.


 


John Scholl, DPM, Lady Lake, FL

02/07/2015    

CODINGLINE CORNER


Query: Medicare "Dark" Days


 


I have not gotten paid in about two months from Medicare, and my billing service keeps telling me about these "dark" days that Medicare has. Can someone please explain this to me in plain English? This has happened a couple of times before. How can I run my practice not having gotten paid in two months? 


 


Jahangir Habib, DPM, Pottsville, PA


 


Response: Because of fee scheduling issues, CMS instituted a hold on all payments for services rendered during the first two weeks of January. However, payments should have been re-started after January 15th. The term "dark days" are otherwise used by carriers during times when they are updating their systems. Usually, these occur during the weekend or non-business hours. Since you are continually getting the same answer from your biller and you are having significant payment issues, you might want to call your carrier yourself and be sure that there is not some other issue(s) going on. 


 


Paul Kesselman, DPM, Woodside, NY


 



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02/04/2015    

CODINGLINE CORNER


Query: Denial for Excision of Benign Lesion


 


I have a patient who had a bleeding growth on the bottom of his hallux that I excised and utilized primary closure. I billed it as CPT 11422 (excision of a benign skin lesion), utilizing ICD-9 729.5 and ICD-9 216.9 (benign neoplasm of skin, site unspecified). This was denied by my Medicare carrier. The pathology report later revealed the lesion to be an "acral fibrokeratoma." What would be the correct way to bill this? 


 


Jack Reingold, DPM, Solana Beach, CA


 


Response:  I think your mistake was in coding it as "benign". The payer probably thinks, if you know it's benign, why should we pay you to remove it? In the remote past, I would have submitted the claim with a diagnosis of neoplasm of skin of uncertain behavior. But my good friend Harry Goldsmith recently clarified to me that lesions of "uncertain behavior" are instances when the pathologist has to determine what it is. That is to say, it's a pathologist's diagnosis- not a surgeon's. 


 


The correct diagnosis code is neoplasm of skin of "unspecified behavior." That diagnosis implies you aren't really sure what it is, and it bothers the patient, so you removed it and submitted it for pathology. I don't see any problem with your procedural coding at all. Resubmit the claim with the revised diagnosis coding. 


 


Rick Horsman, DPM, Olympia, WA

 



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01/31/2015    

CODINGLINE CORNER


Query: Nursing Facility vs. Group Home Setting E/M


 


I was asked to see patients in a group home setting. In looking at the E/M categories, I believe that a group home is in the nursing facility category. I have not seen patients in a nursing home/facility for a number of years. Are there requirements such as having an order from the attending or primary care physician to see the patient? I also remember something about not being able to bill for an initial E/M, as only the admitting PCP can bill for that type of visit in the facility. Is that correct? 


 


Louis Scotti, DPM, Nesconset, NY


 


Response:  I recommend looking at the Domiciliary, Rest Home, (e.g. Boarding Home), or Custodial Care Services codes: CPT 99324-99337. The place of service code is 14 for Group Home and 33 for Custodial Care. These CPT codes do not have a medical care component. They are distinguished by new or established patients. It is best to contact the facility and ask how they are designated before seeing patients. Even if you are provided a room to use for your work, please do not bill place of service 'office', as in order to do that, one would have to bear the expense for the office setting. 


 


There must be an initial order on record from the patient's PCP for podiatry care. I recommend asking whomever contacts you if the order is written for each patient. I have not seen any guidance that this order must be renewed in a certain period of time. The new patient codes for Domiciliary, Rest Home, Boarding, or Custodial Care will closely fall into the same realm as office visit coding. The Initial E/Ms for nursing home patients (which do not distinguish new vs. established) would not, as they are designed for the first visit by the PCP for a detailed/comprehensive evaluation for the entire care of the patient. This may or may not include the written order for podiatry care. 


 


Karen Hurley, CMM, CPC, Lakewood Ranch, FL


 



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01/28/2015    

CODINGLINE CORNER


Query: Hardware Removal


 


Our doctor removed a pin and an external fixator under fluoroscopy in the ASC. The patient was under IV sedation (not general anesthesia) with the soft tissue locally anesthetized. Can we code both procedures, CPT 20680 and CPT 20694-52 (reduced because no general was administered)? 


 


Codingline Archive Question


 


Response: If the pin is buried (not protruding above the skin), and it requires an incision to remove it, you can bill CPT 20680 (if deep - at level of bone) or CPT 20670 (if superficial, buried in the subcutaneous tissue). 


 


You cannot bill CPT 20694 if you remove it under a local with sedation. "CPT Assistant" (July 2000) notes: "CPT code 20694, Removal, under anesthesia, of external fixation system, may be reported if the removal procedure is performed under general anesthesia. General anesthesia is not usually required to remove an external fixation system, therefore, removal not requiring anesthesia is not a separately reportable service." You cannot alternatively add a "-52" reduced service modifier since the value assigned the application includes removal without general anesthesia. 


 


Harry Goldsmith, DPM, Cerritos, CA 


 



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01/24/2015    

CODINGLINE CORNER


Query: GraftJacket Plantar Fat Pad Augmentation


 


How would you code placement of an acellular matrix (using the parachute technique) for augmentation of the fat pad underlying a lesser metatarsal head? Or more than one? I was thinking of using CPT 15002 wound bed preparation with CPT 15777 (implantation of biologic implant [e.g., acellular dermal matrix] for soft tissue reinforcement [e.g., breast, trunk]) for graft placement, as it is not a stand-alone code. Or does this fall in the unlisted procedure box? 


 


Wendy Winckelbach, DPM, Greenwood, IN


 


Response: There is no code for this. I believe the most appropriate code is CPT 28899 (unlisted procedure, foot or toes). CPT 15002 is not appropriate because there was no wound bed preparation performed. I suggest you pre-certify or check with the payer before performing this procedure as some may consider this "experimental" and not reimburse it. 


 


Jeffrey Lehrman, DPM, Springfield, PA 


 



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01/21/2015    

CODINGLINE CORNER


Query: Billing Bioguard Gauze


 


We are beginning to dispense Bioguard gauze rolls (http://www.dermasciences.com/bioguard) from our office for Medicare recipients. We are using the appropriate A6266 code for this product. We are, however, having a very difficult time locating information on how many units patients are eligible to receive monthly. When appropriate, I thought we could dispense up to 120 units, regardless of number of wounds we are treating. We are only getting reimbursed for 30 units when there is only one wound. Our LCD does not mention how many units are reimbursable. Can anyone provide guidance?  


 


Daniel C Albertson, Office of Paul Krestik, DPM, London, KY


 


Response: This product appears to be an impregnated gauze (other than with saline, water zinc paste or hydrogel). It can be billed once per day per wound. On a monthly basis, you would be limited to no more than 30 per wound. This is clearly stated in the Medicare DME "Surgical Dressings" LCD. 


 


If you are treating four non-contiguous wounds which required four separate sponges (where cutting the sponges would not allow for adequate coverage), then you could be paid for 120 units. Your claim form would indicate this by using an "A4" modifier. Your documentation would, of course, need to support this level of service. 


 


Paul Kesselman, DPM, Woodside, NY  


 



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01/17/2015    

CODINGLINE CORNER


Query: Coding Lesser MPJ Joint Replacement


 


What code is used for a total joint replacement of a lesser metatarsal-phalangeal joint? I believe CPT 28293 is only for the 1st metatarsal-phalangeal joint. 


 


Jeffrey Cohen, DPM, Englewood, NJ


 


Response: There are no codes for joint replacements of the lesser metatarsal joints. You would need to use CPT 28899 (unlisted, foot/toe) and provide documentation with an operative report. Request a peer review. 


 


Howard Zlotoff, DPM, Camp Hill, PA


 



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01/14/2015    

CODINGLINE CORNER


Query: Medicare: *-59* Modifier - Allowed or Not?


 


I have heard conflicting advice regarding being able to use the "-59" modifier with Medicare. Are we allowed to use it only under certain circumstances or at our discretion or not at all? 


 


Andrew Resler, DPM, New Windsor, NY


 


Response: Well, you have to meet the criteria for the use of modifier "-59" in order to use it in the first place. If another modifier -- for example modifier "-51" or "-76" - appropriately describe the special circumstances, then you shouldn't be using modifier "-59" at all. But if your question had to do with using modifier "-59" instead of the new "X" modifiers, then, yes, at this point in time, you can use EITHER "-59" or the applicable "X" modifiers. 


 


I'm telling my clients to stick with modifier "-59" until CMS comes out with better clarification for how the "X" modifiers should be used. That transmittal last year was confusing and in some cases, redundant (meaning it looked like they were telling you that two of the 4 modifiers could apply to the same kind of situation). I'd hate to start using the "X" modifiers only to find out that CMS meant something entirely different by the definitions for some or all of them. Essentially, the most conservative way to go is to stick with modifier "-59" until CMS tells you that "-59" can no longer be used. Hopefully, by that time, they'll have figured out what they really want to accomplish with the "X" modifiers and will have done a better job of communicating their intent to the provider community. 


 


Joan Gilhooly, CPC, CPCO, Lebanon, OH 


 



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01/10/2015    

CODINGLINE CORNER


Query: B/P, BMI - How Often Does It Needed to Be Done?


 


How often do we need to take a blood pressure and BMI to satisfy requirements? Does it have to be at each visit? 


 


Steven Rothstein, DPM, Manchester, NH 


 


Response: Assuming you are referring to the requirements for meaningful use, here is the explanation from CMS regarding this measure (as you can see, you must do it once per reporting period, but after that, it is your determination about updating as it is regarding how the data is obtained). Just remember if you are also doing the PQRS measure on BMI, that measure actually requires that you weigh and measure the patient to determine the BMI: Height, weight, and blood pressure do not have to be updated by the EP at every patient encounter. The EP can make the determination based on the patient’s individual circumstances as to whether height, weight, and blood pressure need to be updated. 


 


Vital sign information can be entered into the patient's medical record in a number of ways including: direct entry by the EP; entry by a designated individual from the EP’s staff; data transfer from another provider electronically, through an HIE or through other methods; or data entered directly by the patient through a portal or other means. Some of these methods are more accurate than others, and it is up to the EP to determine the level of accuracy needed to care for the patient and how best to obtain this information. 


 


Jim Christina, DPM, Bethesda, MD 


 



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01/07/2015    

CODINGLINE CORNER


Query:  New *X* Modifier Use


 


With the farewell to modifier "-59", would someone clarify the usage of modifier "XS" and "XU" with reference to the following scenario? If CPT 11721 is performed with a CPT 20550 (and J1100-A5), would the correct submission be CPT 11721-XS, CPT 20550, J1100-A5? 


 


Howard Dinowitz, DPM, Brooklyn, NY


 


Response: Modifier "-59" is not gone. If you are compelled to use these new modifiers, then select whichever of these best fits your service. Here are the CMS definitions for the two modifiers expected to be used by foot and ankle specialists: 


 


XS - Separate structure, a service that is distinct because it was performed on a separate organ/structure 


XU - Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service 


 


In the example you gave, prior to January 1, 2015, the coding for Medicare would be: CPT 11721, CPT 20550, J1100. There is no CCI edit bundling of CPT 20550 and CPT 11721. Medicare, however, has said that if or when there is an edit between two codes, it will still recognize the "-59" modifier. I feel that modifier "-59" should be able to be used in 2015. We are all looking for more information and direction from CMS on their modifier creations. 


 


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


 



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01/03/2015    

CODINGLINE CORNER


Query: Surgery Coding for Joint Replacement


 


A patient came to our office who had left foot surgery performed (lesser joint replacement with Swanson implants) by another podiatrist. However, the joint implants on the 3rd, 4th, and 5th metatarsals have broken and the implants need to be removed, and either replaced or the joints stabilized by pinning the toes to hold their position while they heal. How do I code these procedure options? 


 


S.F. Charley Hartley, DPM, Houston, TX


 


Response: If the implants are removed and nothing else done besides pinning the joint, then I would suggest CPT 20680 (removal of implant; deep), each.  If you are removing and replacing the implants, there is no single code that defines this. You either have to use the removal code, CPT 20680, with or without a "-22" modifier, or use the unlisted foot/toe procedure code, CPT 28899. Note that a number of payers still consider use of lesser metatarsal-phalangeal joint implants as investigational, so pre-authorize the surgery. 


 


Tony Poggio, DPM, Alameda, CA 


 



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01/01/2015    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Gregory Mowen, DPM


 


It was recently debated whether we can bill for an office visit for performing a comprehensive diabetic foot exam along with a routine care code (i.e.11720); or should the exam be scheduled separately? I think it is absolutely appropriate and defendable to do them on same day if your allotted time allows. Often, at this visit, I have Doppler and/or more advanced neurologic testing done if the risk factors are met.


 


We do try to make it convenient for the patient, when possible, versus re-appointing. I do feel that the comprehensive exam is excellent for the patient, plus it may open new revenue streams for the practitioner. 


 


Gregory Mowen, DPM, Ventnor, NJ

12/31/2014    

CODINGLINE CORNER


Query: Annual Lower Extremity Examination


 


A patient with diabetes and the appropriate class findings (excluding neuropathy) returns for treatment of painful mycotic hallux nails (laboratory +) and plantar hyperkeratosis. Assuming there are no new complaints and no significant changes in medications or medical status, can an "annual lower extremity examination be performed (E/M code CPT 99213) as well as nail debridement (CPT 11720) and debridement of the hyperkeratoses (CPT 11056)? 


 


Charles F. Ross, DPM, Pittsfield, MA 


 


Response: It is good medical practice to perform at least a yearly (or more frequent) lower extremity examination or what Ken Malkin, DPM termed a comprehensive diabetic foot exam (CDFE) based on your patient's diabetic symptoms. However, based on some MAC LCDs and other retired LCDs from previous Medicare carriers, it is my suggestion that you perform that examination on a different day from the day you perform covered routine foot care services. Some LCDs and a lot of the retired LCDs (or their associated articles) say that you cannot perform (and be paid for) an E/M visit on the same date as the covered foot care services for the purpose of qualifying the patient for that covered service. 


 


So as not to confuse the issue and run the risk of having the E/M denied or worse, bring the patient in and do your evaluation on a different day. 


 


Paul Kinberg, DPM, Dallas, TX 


 



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12/29/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Estelle Albright, DPM


 


I suggest instead doing a punch biopsy rather than a destructive procedure. I have found these often are verrucae rather than porokeratomas. Code dx = skin neoplasm of uncertain etiology. You can bill for the skin biopsy based on the size of the lesion. 4mm or less needs no sutures, and these heal quickly and leave no scar, and I have never had a recurrence.


 


Estelle Albright, DPM, Indianapolis, IN

12/27/2014    

CODINGLINE CORNER


Query: Revisional Lapidus Non-Union Coding


 


How would you code a revisional Lapidus-type procedure non-union using bone allograft? 


 


Elliot Michael, DPM, Hillsboro, OR


 


Response: There are three codes that could apply:


CPT 28320 which is repair of non-union tarsal bone or 


CPT 28322 which is repair of non-union metatarsal bone or 


CPT 28740 which is an arthrodesis tarometatarsal joint, which you are repeating (i.e., you are repairing only the fusion part of your original CPT 28297 procedure). 


 


The first two are typically reserved for intraosseous non-union pathology. The attempted fusion of the first metatarsal and the medial cuneiform tried to "create" a single bone. The latter code takes what did not work, and repeats that portion of the procedure. Select the codes that you best feel reflects the procedure you perform. The use of allograft is not coded. 


 


Tony Poggio, DPM, Alameda. CA 


 



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12/26/2014    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Todd Lamster, DPM


 


These lesions, the small punctate epidermal hyperkeratoses, exist within the epidermis, and should be coded as nothing more than 700 or 701.1, in my opinion.  If one looks up 757.39 in any ICD-9 book, or on CMS.gov, the definition is "other specified anomaly in the skin", under the section of CONGENITAL ANOMALIES OF THE INTEGUMENT. These lesions, which we see so often, are not congenital, so I have stopped using that code as I feel it is a misrepresentation of the pathology.


 


There is an article on this subject by Drs. Bakotic and Shavelson from Podiatry Management. It did not review how to code the lesions we see daily in the office. I would like our experts in podiatric dermatology to weigh in.


 


Todd Lamster, DPM, Phoenix, AZ
GSource