Coding

“I am reading conflicting information regarding the dispensing of a post-operative/cast shoe. Medicare never seems to pay for this but commercial carriers usually do. I am reading that this shoe is NOT separately payable when it is dispensed in conjunction with a surgical procedure code. You cannot have the patient sign an ABN and charge the patient for the shoe. Please clarify the dos and don’ts of using the L3260 HCPCS code.”

When providing Pneumatic Compression Devices (PCDs) to patients, be sure the patient meets all Medicare coverage criteria. Recovery Auditors perform complex reviews on claims for these devices to determine if the PCD is reasonable and necessary for the patient’s condition based on the documentation in the medical record. Claims that do not meet the indications of coverage and/or medical necessity will be denied. Affected codes are E0650, E0651, E0652, E0656, E0657, E0667, E0668, E0669 and E0670.

Hospital emergency department services are not payable for the same calendar date as critical care services when billed for the same beneficiary, on the same date of service and by the same service provider (based on Tax ID and Provider Specialty Code). Affected codes: 99281, 99282, 99283, 99284, 99285.

“I have a patient who will undergo a Cartiva implant procedure for hallux limitus/rigidus at the 1st metatarsophalangeal joint. He also has lateral deviation of his hallux on the same foot and an Akin osteotomy will be performed to address this deformity. Should the Akin osteotomy be billed as a separate procedure or is that considered unbundling?”

“We are having difficulty with a denial when combining CPT 28320 and CPT 20680. CPT 20680 is being rejected as unbundling. According to CCI edits, CPT 28320 is a Column 1 code and CPT 20680 is a Column 2 code and they are allowed. The surgeon removed hardware from a prior surgery performed by a different surgeon not associated with the practice then repaired a non-union and applied new fixation. Is the removal of prior hardware actually included in CPT code 28320? If not, what modifier should be used if it is the same incision/surgical site as the non-union repair?”

“Can CPT code 29580 (strapping – Unna’s boot) be used for ICD code M65.871(2) in lieu of CPT code 29540? If not, what is the best ICD 10 code for CPT 29580?”

“I need some clarification on the proper coding for a paronychia on an established patient office visit. I’ve received mixed advice over the last year or so. Anything from CPT 10060 alone, to adding CPT 64450 and CPT 99212. I just want to be correct.”

“I attempted to remove a screw under local anesthesia in the office setting that was placed during a bunion correction about 10 yrs ago. I was unsuccessful and the patient will need to undergo the procedure in the operating room. How would I bill this visit? It was a new patient to the office.”

“I have a patient with a hereditary floating 2nd toe, secondary to joint instability and contracture of the extensor tendon and capsular tissue. I have decided that the most appropriate surgical procedures for the correction of this situation are a V-Y skin-plasty and an extensor tendon lengthening and are coded with CPT code 14040 and CPT code 28234, respectively. However, the ICD code M20.5×2 (Other deformities of toe(s) (acquired), left foot) does not seem to be listed as a potential diagnosis for the above CPT codes. Please help!”