Coding

“My billing team and I have a difference of opinion. If we apply more than one graft, they have been using modifier -76. It is getting paid, but I am not sure that is the appropriate use of the modifier. I just assumed that we would bill for total units. However, each graft has a unit number. So, if we bill double the units, we need a way to alert the insurance company why the units are doubled. This is why we started using the 76 modifier. Any input would be appreciated.”

“I have a question concerning Medicare’s rules when billing for repeat CPT 11750. What is the recommendation for billing these for a regrowth following a previous CPT 11750? In another scenario, on the same subject, what if the procedure needs to be performed on a nail border that is adjacent to one that was already billed? Can and should we use an ABN and upon denial, bill the patient?”

“How are fracture care codes used? If a patient comes into the clinic with a fracture that you plan on eventually operating on, can you bill a closed fracture care code and then bill the surgical code when the open reduction and internal fixation is performed in the operating room?”

“So, to be clear you can never use L3000KX for a diabetic with neuropathy and diabetic ulcers even if secondary will pay.”

“Any thoughts on whether ICD-10-CM codes N18.1-N18.6 (chronic kidney disease) are “asterisk” covered diagnoses’ for nail and callus codes? I practice in Illinois. If so, are the date of last service and a Q modifier all that are needed?“

“After watching some E/M presentations, it was suggested that hospital consultations should be billed with CPT 99252-CPT 99255. When we billed these codes, our EMR system and our clearing house rejected the codes. They are saying effective 1/1/2010, CMS has announced that they will reject codes. Are we billing the right codes?”

“I do some part time work in a wound care center. I frequently use CPT 97597 for coding. My biller is telling me not to bill CPT 97597 because it reimburses around $25 or less in a wound care center. However, the facility likes and even encourages me to use CPT 97597. If I do a selective debridement, can I bill CPT 99213 or CPT 99212 instead of CPT 97597?  I know that I should not bill CPT 99213-Modifier 25 if there isn’t a separate complaint. Am I required to bill 97597? Is this a scenario that I should be considering CPT 11042?”

By Dr. Michael G. Warshaw, DPM, CPC

“I’m in an ongoing debate with my biller. I have always been under the impression that when billing for infected, ingrown nails that local anesthetics were considered part of the procedure. My biller thinks I can charge for them. What is correct?"

“I have a patient with a longitudinal striation of her toenail, and we are going to biopsy the nail bed. What ICD-10 do code would you consider for the diagnosis for the biopsy? What is the CPT procedure code for the nail matrix?”