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04/28/2005    David Solomon, DPM

Coding a Ray Resection

Query: Coding a Ray Resection


What is the best CPT code to use when removing
the metatarsal and toe (with accompanying
resection of necrotic tissue and reapproximation
of tissue for closure) secondary to a severe
diabetic foot infection? Effectively, the
procedure will narrow the foot.


David Solomon, DPM
Los Angeles, CA


Codingline Response: CPT 28810 (amputation
metatarsal and toe) describes a ray amputation.
Debridement and closure of the surgical wound
would be included in the allowance. Keep in mind
that CPT 28810 is not a frequently performed
procedure for most foot surgeons. It is not
elective, and usually is the result of
infection, necrosis, severe injury, etc. CPT
28810 has a 90-day Medicare global period
assigned.


Tony Poggio, DPM
Alameda, CA


Other messages in this thread:


04/30/2005    Harry Goldsmith, DPM

Coding a Ray Resection (Alicia Lazzara, DPM)

RE: Coding a Ray Resection (Alicia Lazzara, DPM)
From:


Dr. Lazzara misquoted Dr. Poggio's comment in
her response (before
it went off into left field). She said, "in the
Codingline response
to the inquiry of billing a partial ray
resection the panelist chose
to include his opinion that the 28810 code
is 'not frequently
performed by most podiatrists'." Dr. Lazzara,
that is
not what he said. The actual quote from Dr.
Poggio was "Keep in mind
that CPT 28810 is not a frequently performed
procedure for most foot
surgeons. It is not elective, and usually is the
result of
infection, necrosis, severe injury, etc...."


Why would Dr. Lazzara assume Dr. Poggio is only
speaking about
podiatrists? Why would she doubt that CPT 28810
(amputation,
metatarsal, with toe, single) is infrequently
billed by most foot
surgeons? (I don't have the orthopedic surgeon
numbers, but for
podiatrists billing Medicare in 2002, it ranked
169th in frequency
billed)


Where in the world did Dr. Lazzara come up with
the impression that
Dr. Poggio's words represented a "false
statement" or "sets up a
dangerous scenario"? By what logic did she
connect what Dr.
Poggio said to "Now all of a sudden, a
podiatrist submits a bill for
a service they performed only to get back a
denial letter or a
having it being down-coded. This is exactly
what happens when you
try to 'umbrella' all services performed by a
specialty....remember
insurance companies force these constraints; we
do not have to buy
into them (unless, of course you are being paid
to do so)." Huh?


I suggest that Dr. Lazzara re-read Dr. Poggio's
comments. She
probably owes him an apology.


Harry Goldsmith, DPM
CEO, Codingline
Cerritos, CA


04/29/2005    Alicia Lazzara, DPM

Coding a Ray Resection (Tony Poggio, DPM)

RE: Coding a Ray Resection (Tony Poggio, DPM)
From: Alicia Lazzara, DPM


I found it interesting in the Codingline
response to the inquiry of
billing a partial ray resection the panelist
chose to include his
opinion that the 28810 code is "not frequently
performed by most
podiatrists." Wouldn't the frequency a
podiatrist performs this
procedure correlate to the type of practice they
have? It certainly
is something I perform in my practice on a
pretty consistent basis,
owing to the fact that I take ER call and am
consulted by the
vascular services at the hospitals I am on staff
on...it is not such
an unusual scenario to perform a partial ray
resection on a
patient.


Why did I feel the need to write in? Well, the
seemingly innocuous
statement by the panelist sets up a dangerous
scenario if this
person is a consultant to any of the insurance
companies, including
Medicare, and false statements such as that
begin to dictate
policy. Now all of a sudden, a podiatrist
submits a bill for a
service they performed only to get back a denial
letter or a having
it being down-coded. This is exactly what
happens when you try
to "umbrella" all services performed by a
specialty....remember
insurance companies force these constraints; we
do not have to buy
into them (unless, of course you are being paid
to do so).


Alicia Lazzara, DPM
Bayside, NY

AAPSM