Coding

For the “At Risk,” Routine Foot Care patient, can a mycotic toenail be debrided, and a corn/callus be trimmed on the same toe?

“I have a patient who had a bunionectomy. The patient was diagnosed with a post operative infection within the global period which required evaluation and management. I billed for an office visit, but Medicare will not pay. What am I doing wrong? I used 24 as a modifier.”

“I have had a RAC audit for a L1951 (from performant) claiming an overpayment stating, “the custom- fitted orthosis did not include a detailed description of the necessary modifications.” L1951 is a prefab which does not require modifications. Where can I go to get any documents (Medicare preferred) stating that L1951 is prefab and as such does not require modifications to respond to this demand?”

“Can I bill a level 4 E/M code if a patient presents with multiple unique, separate identifiable complaints that I am treating? For example: A patient comes in with complaints of a hammertoe and plantar fasciitis. I am treating both. Can I code a level 4 code and be justified based on the time?”

Top 10 Edits in May 2025 Source of information, National Government Services, Inc. (NGS)

“I saw an established patient who returned to the office for At Risk,” Routine Foot Care. The patient also had a new complaint of heel pain. I obtained X-rays the foot and gave a steroid injection in the heel. Can I bill for the Routine Foot Care and those treatments as well?”

“I performed a Lapidus bunionectomy that went on to a subsequent nonunion of the arthrodesis site. We are planning a return to the operating room to revise it. Any suggestions on the best ICD-10 code and best CPT code to use in this situation?”

For an unannounced Durable Medical Equipment (DME) site visit, you'll need to have readily available documentation demonstrating compliance with DMEPOS supplier standards, including licensure, insurance, inventory, complaint resolution protocols, and instructions for beneficiary use. The inspector will verify this information and may also take photographs of the facility. This should not be a surprise. When you applied for your DME ID number, you filled out the Medicare enrollment application, form CMS-855S, and when you signed the application, you agreed to follow the rules. Here are the rules for what needs to be present when an unannounced DME on site visit occurs.

“My clinic is at the local hospital. I send X-rays to the radiology department. They are eventually read by a radiologist. However, I actually evaluate the x-rays and interpret them myself. Can I bill that component of the radiology fee? And if I do, will it affect the radiologist reimbursement?”

“With the loss of CPT 99343, is time a justification for the use of CPT 99344? My initial home visits (and now assisted and congregate living facilities) easily meet or exceed sixty minutes. Before I see patients, they completed a five page demographics that includes two pages of review of systems. I also have the chart notes from the referring physician and/or the CMS-485 from a home care agency (or the input paperwork from the hospice agency) that is all reviewed while face to face with the patient. The physical exam is quite time consuming in and of itself followed by assessment, treatment, plan of care and coordination of care. It seems that everything I can read says that I am justified in billing CPT 99344 using time. Thoughts?”