Coding

Can the use of an interpreter (ie. different language spoken, hearing impaired) increase the level of E/M service based upon time?

Acceptable methods for handwritten signatures are: 1. A legible full signature 2. A legible first initial and last name 3. An illegible signature accompanied by signature log or attestation statement 4. Initials over a printed or typed name 5. Electronic signature

“Need advice on codes and modifiers.... My associate removed painful hardware from a previous Lisfranc dislocation repair (only removed the hardware from the 1st met-cuneiform joint, not the other tarsometatarsal joints), and redid a 1st met - med. cuneiform arthrodesis with new hardware. He also did a sliding calcaneal osteotomy with fixation. He did a 1st proximal phalanx osteotomy. All on the right foot. Highmark insurance in PA was the health insurance carrier.

“My business partner and I have different opinions regarding this issue and I’m having trouble finding a succinct and primary source document. When performing nail care and callus care for a high-risk patient, can you bill for both when the callus is located on the tip of the toe? It is my understanding that the skin is a separate structure than the nail and thus they are separate diagnoses and CPT codes, but my business partner states he heard a lecture that stated not to charge for calluses that occur on the same toe as a nail that is trimmed or debrided. This seems to be an LCD-dependent decision as I have not been able to locate anything in CMS policy that states either way. Can someone point us in the right direction with primary source reference?”

“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 code 15271-RT for L89.513 and CPT code 15275-RT for L89.613. The NCCI Edits does not show any conflict, but I am wondering whether a -51 is necessary. I also used the correct Q code for the product.”

What Is This Code? When Is It Used? Is it Appropriate to be used in Podiatry?

“I was consulted on a patient in the hospital with a large 5th metatarsophalangeal joint ulceration. There was osteomyelitis of the proximal phalanx and metatarsal head. I performed the resection and subsequently performed a delayed closure several days later. The closure left an area open due to soft tissue deficit. This necessitated post operative wound care. I initially billed CPT 28810 and then subsequently CPT 13160. I billed CPT 11042 weekly post operatively, until the wound healed. The private insurance states that all the CPT 11042 billings are considered part of the global.”

Can the application of a below the knee, non-weight bearing fiberglass cast be billed for in order to treat a fracture?

My associate doctor recently billed for a hospital outpatient surgery: 28005 and 11981. The antibiotic spacer kept displacing during the p/o period, so he went back earlier than expected to do the following, hence the patient is still in the post operative global period from the first set of procedures: 28755 -- 58,RT -- M10.9 20705 -- 58,RT -- M86.9 11750 -- 79,T5 -- L60.0 Is this coded correctly with regard to modifiers and diagnosis codes? I personally have never done a staged procedure, and I know my billing company probably won't know either, so I figured I'd ask here first before submitting and getting hit with denials.

“Has anyone had CIGNA, Tufts, UHC reject CPT code 28310 (Akin osteotomy) as a separate and billable code with a Lapidus arthrodesis/hallux valgus correction with bunionectomy (CPT 28297)? I did appeal with CIGNA and was told that the nurse-coder looked at my appeal and related to me that according to the NCCI Edits, the Akin osteotomy is “part and parcel” included with a Lapidus arthrodesis/ bunionectomy. What is the next step?”