“The NCCI edits talk about having calluses on toes 2-5 that are proximal to the distal interphalangeal joint (DIPJ). However, what about the hallux? We have diabetic patients with class findings that meet the criteria to debride hallux toenails. Occasionally, these patients also have a callus at the medial interphalangeal joint (IPJ). Payment is being denied on appeal due to the rule about not being a separate toe or proximal to the DIPJ. However, the hallux does not have two joints – just the IPJ. Is the IPJ thus considered the most distal joint? And debriding calluses either plantar to the IPJ or medial to the IPJ is included in the code?”
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“I was working at the local wound care clinic last week when this scenario presented itself. The patient was referred from the emergency room for follow for a wound. His wound was a deep wound at the medial malleolus of the right ankle. The posterior tibial tendon was right there, as clear as day. There was necrotic and fibrotic tissue around the tendon. I debrided the area, including the tendon, and all surrounding non-viable tissue. The patient had a superficial wound at the right hallux. Here are my questions:
1. Can we bill CPT 11043 and CPT 11044 in a wound care center?
2. Are we allowed to bill more than one wound debridement during the same visit?
3. Can I bill an E/M for the hallux wound, if only debrided the ankle wound?”