Coding

If a Medicare patient is seen in the emergency department and then surgery is performed later that day or night, can the emergency department consult be billed with a modifier -57 along with the surgery? We have been under the impression that, at least in the office, the visit to decide to do the surgery is included in the surgical fee. Are we correct and does this apply to the encounter in the emergency department too?

“I have an unusual situation that I am trying to figure out how to code. I had a patient return to the office in the global period after I performed a 1st metatarsophalangeal joint (MTPJ) arthrodesis. Although, the alignment of the fusion looks good, one of the non-locking screws advanced out of the bone and plate and started to tent the skin at the incision site at three weeks post operative. She is neuropathic and denied any trauma to the area. I removed the screw in the office with local anesthesia. Can I bill for unplanned screw removal in the office?”

“I have a patient who had a chevron bunionectomy 10 years ago. The bunion has returned and the head is facing lateral. My plan is to perform a Lapidus procedure to reduce the first intermetatarsal angle and a rotational 1st metatarsal head osteotomy to align the articular surface (basically an Austin with a medial based wedge removed from the dorsal osteotomy to rotate the head slightly medial). How would you recommend I code this (ICD-10 and CPT codes)? Can I use CPT 29297 and CPT 29296? I’ve also considered CPT 28740 with CPT 29296. Thanks.”

“Can you describe what is a “sufficiently detailed exam” to confirm the diagnosis of peripheral arterial disease? I was audited and the debridement of calluses were denied even documentation of every single class finding were listed. Are we supposed to do ankle brachial indexes, Buerger’s test, etc? Why have class findings if they do not qualify as “sufficiently detailed?”

CPT code 11755 is defined as the following: Biopsy of nail unit (e.g. plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure). It is amazing to me how often this CPT code is misused and abused.

1. Are podiatrists allowed to perform a fall risk exam only in specific cases (in patients over 65, ones with prior history of falling, etc.) or general wellness exam G0438? Question #1: Podiatrists are certainly able to perform an annual fall risk assessment. The Centers for Disease Control and Prevention (CDC) and the American Geriatric Society recommend yearly fall assessment screening for all adults 65 years of age and older. If the screening shows you are at risk, you may need an assessment.  A fall risk assessment should be offered to older people who have had one or more falls in the past year or demonstrate abnormalities of gait and/or balance.

“Can ‘At Risk,’ Routine Foot Care be billed for a patient that has evidence of neuropathy, no vascular impairment and no Class findings?”

“Medicare DMERC B jurisdiction has stopped abruptly allowing and paying for L3010 using RT KX and LT KX. I cannot find any information about new modifiers or other info needed. Any suggestions? I do accept Medicare assignment.”

“The original procedure that was performed was a hallux interphalangeal joint arthroplasty to resolve a medial, diabetic ulcer. An infection developed that led to a hallux amputation. Does the global of the first surgery (arthroplasty) stay in place or is it reset by the zero-day global for the second surgery (amputation)?”

A claim for orthotics, L3000 right and L3000 left is being sent to Care-First Blue Cross Blue Shield Washington DC. Question: is Place of Service still #12 (Home)? I ask because a claim was recently denied for POS 12 for orthotics (too early to know if changing it to Place of Service 11 for Office was successful.