Coding

“We had a patient present with a fracture of her foot. The debate in the office is the ICD-10-CM definition of “subsequent care” as it refers to trauma. We saw the patient, diagnosed a fracture and chose to treat the fracture with conservative care. Would those follow up visits be considered “subsequent care” or “initial care” while we follow through with the initial treatment for the fracture?”

“I have a patient with a nonhealing pressure wound on his right ankle and his right heel. I applied a skin graft substitute to both sites. I used a single piece and shared it between the two sites. The ICD 10 code I used for the ankle is L89.513. The ICD 10 code I used for the heel is L89.613. For the application codes I utilized CPT 15271-RT to the L89.513 and CPT 15275-RT to the L89.613. The CCI does not show any conflict, but I am wondering whether a -51 is necessary. I also used the correct Q code for the product.”

“Medicare pays approximately $40 more for an E/M 99213 versus an injection for a neuroma injection. Can you give the injection and only bill the E/M 99213?”

“A new patient was seen with heel pain. X-rays were taken at an outside facility, and I independently interpreted these and reviewed the labs. Based on medical decision making, I believe I should be coding CPT 99204. The patient had one new, acute problem (previously undiagnosed) and I independently interpreted tests. To me this is a no brainer, but my office staff argues that they believe it should be CPT 99203. Thoughts?"

“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 we 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 as to why the units are doubled. This is why we started using the 76 Modifier. Any input would be appreciated.”

“How are we supposed to bill CPT 11057 to Medicare to get paid? For the typical patient, we currently use the ICD-10-CM codes E11.42, E11.51, L84, R26.2. We bill this as its own claim. We put the podiatrist as the referring physician. We do not use any modifiers and we previously used the Q8 Modifier when appropriate, but it was denied. What does the proper 1500 form look like for CPT 11057?”

“Medicare sent me a letter about 6 months ago saying I bill CPT 11721 too often compared to CPT 11720 and CPT 11719. However, they consistently deny the combination of CPT 11719 and CPT 11720-59. Not just bundled, but deny both codes, altogether. That then leaves me an outlier with a bunch of CPT 11721 counted and all of the CPT 11719 and CPT 11720 denials left out of the calculations. Appeals are denied (and a waste of time and resources for $11). Their CCI indicator is 1, meaning they can be billed together with 59 or X- modifier on the column 2 code (CPT 11720). Is it fraudulent billing to code only CPT 11720 even though I am debriding 1 to 4 nails and trimming the rest? It also pays more with just CPT 11720 since it is otherwise secondary to a less-than-$11 CPT 11719 code. I hate to turn away these patients who have a true need. Recommendations?”

“I have a patient who had a hammer toe deformity, and this required repair of the second toe. Unfortunately, the surgical site developed osteomyelitis. This complication occurred at postoperative week number four. I returned to the operating room to perform an amputation of the second toe because of osteomyelitis. I would like to hear thoughts on the appropriate modifiers. And how does the zero-day global period for the amputation play into the billing for the post operative care?”

“The patient initially had a gastroc recession at the right lower extremity. Our surgeon performed a debridement procedure of the right foot ulceration. It was performed in the clinic, and we planned to code it as CPT 11042. However, the patient is in the 90-day post op period from the initial surgery that was performed 4 weeks ago. Is a modifier necessary to submit for payment? Is it 79?”

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