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Coding

Coding

Complicated Toenail Surgery

by Dr. Michael Warshaw, DPM, CPC

“I have a rheumatoid patient with a grossly deformed interphalangeal joint with significant osseous malformations leading to a chronic ingrown toenail on the hallux fibular border. I have ruled out any infection, osteomyelitis, or neoplasm. The bone is grossly hypertrophic and needs excision along with the nail structures on the fibular border. There also may need to be some plastic closure performed. What are the appropriate ICD10 and CPT codes reflective of this scenario?”
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Coding

Injection Denials

by Dr. Michael Warshaw, DPM, CPC

“I have been getting denials from BCBS, First Care, Aetna, and UHC on claims billed out with diagnosis codes M72.2, M71.571, M71.572, M77.31, and M77.32. Has anyone else had this problem lately? The NDC number and the description are on the claim. The claim is going out as follows: CPT 99213 25, CPT 20550 RT, CPT 20550 LT, J0702 x 2 units, J1030 x 2 units.”
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Coding

Diabetic Shoes and Amputees

by Dr. Michael Warshaw, DPM, CPC

“I’m trying to determine the coverage of diabetic shoes for a patient who has had one foot/leg amputated. Somewhere in my brain I seem to remember that Medicare will cover a pair of shoes so the amputee can wear the shoe on his prosthetic. Does this also apply to heat moldable inserts? Can we dispense them for the shoe that will be used on the prosthetic leg? I would appreciate any thoughts on this situation. I have read the LCD and associated article but can’t seem to fully understand how this works.”
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Coding

Plantar Keratosis Combination

by Dr. Michael Warshaw, DPM, CPC

“Is the debridement of a plantar keratosis (CPT 11055) at the first metatarsal head considered bundled with nail debridement (CPT 11720)?”
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Coding

Cigna and Modifier 25

by Dr. Michael Warshaw, DPM, CPC

“I just received a letter from Cigna insurance. As of August 13, 2022, they will require the submission of office notes with claims submitted with Evaluation and Management/E and M codes (ie. 99212, CPT 99213, CPT 99214) appended by modifier -25 when a minor procedure is also billed the same day by the same physician. The E/M will be denied if documentation is not received. The claim can be sent electronically with attachment indicator and notes should be faxed. Is this happening with other insurance companies? The amount of paperwork for a small office is crazy and along with continued decreasing reimbursements, higher prices for supplies, shortages, etc. The insurance companies are making greater profits than ever. The insurance premiums have increased and out-of-pocket patient billing has become more significant. The system is not right. What can we do? How do we fight back? Please don’t say take cash rather than insurance, it’s not practical in many circumstances. Any thoughts?”
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Coding

Matrixectomy Follow Up

by Dr. Michael Warshaw, DPM, CPC

“I have a patient who has Blue Cross insurance. He came in for a matrixectomy on February 8th and returned on February 15th for follow up. I billed CPT 99213 using M79.673 and T81.40XA for the follow up and the claim was denied. Is there another code or modifier that I should include?”
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Coding

Wound Care Coding: Recurrent and Frequent Treatment

by Dr. Michael Warshaw, DPM, CPC

​​​​​​​“I have a Medicare patient that has healed a neuropathic ulcer (L97.522, E11.62) at the plantar base of his 5th metatarsal. He needs paring of the hyperkeratotic tissue, frequently with hemorrhagic changes, every four weeks or he re-ulcerates at this location. Should this be coded as: CPT 11055 using a GY modifier every other visit? Debriding devitalized tissue CPT 97597 or am I evaluating and managing an ulcer CPT 9921X?”
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Coding

Plantar Fascia Rupture

by Dr. Michael Warshaw, DPM, CPC

“What would be the best code or codes to represent an acute, ruptured plantar fascia?"
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Coding

Injections Under Fluoro

by Dr. Michael Warshaw, DPM, CPC

“My partner prefers to inject the subtalar joint under fluoroscopy. What would be the best procedure code to bill for an injection of the subtalar joint and does the use of fluoroscopy change things?”
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Coding

E/M Revisited

by Dr. Michael Warshaw, DPM, CPC

“For Medicare, it has been well established that debridement for callouses is not covered when class findings are not present. But what about that patient that complains of pain from a callus. If you evaluate the painful callus and manage the painful callus, would it not be appropriate to bill a low level E/M code? This patient does not want surgery but this is a recurring problem. Can the E/M be billed each time the patient is seen?”
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