Coding

“How do you code for a hospital consultation when the patient is in the postoperative global period from another surgeon? I was called to the local hospital to see a patient that was transferred for medical treatment for an unrelated condition. He had a transmetatarsal amputation (TMA) performed for apparent osteomyelitis at the other hospital by a different podiatric surgeon. I was consulted to evaluate the TMA site and make recommendations for management. How do I code the diagnosis and E/M for this post-operative consultation?”

“I saw an established patient who returned to the office for “At Risk,” Routine Foot Care. The patient also had a new complaint of heel pain. I obtained X-rays of the foot and gave a steroid injection into the heel. Can I bill for the “At Risk,” Routine Foot Care and those additional treatments as well?”

If a patient comes into the office/clinic and is diagnosed for example with a fracture at the base of the 5th metatarsal on the right foot and the physician eventually plans to operate on the fracture, there are a few options to explore and consider.

What are the relevant ICD-10 codes that are accurate to describe conditions like “excessive pronation”, varus/valgus, or pes cavus issues?

Part I: What are the coding documentation guidelines for Level 4, specifically 99204 and 99214 using Medical Decision Making? Part 2: What level of E/M service does the treatment of a paronychia qualify for?

When selecting the level of E/M service based upon medical decision-making, the best source of information is the Level of Medical Decision-Making Table. The table includes the four levels of medical decision making (ie, straightforward, low, moderate, high) and the three elements of medical decision making (ie, “number and complexity of problems addressed,” “amount and/or complexity of data reviewed and analyzed,” “and risk of complications and/or morbidity or mortality of patient management”). To qualify for a particular level of medical decision making, two of the three elements for that level of medical decision making must be met or exceeded. It is under “Number and/or Complexity of Problems Addressed” that the issue of acute versus chronic is addressed. Acute versus chronic is not based upon a “time frame.”

“I have a patient who returns to the office for regular treatment of a hyperkeratotic lesion. Our documentation states “a hyperkeratotic lesion with a punctate keratin core with obliteration of skin tension lines to the sub 5th metatarsal head.” The plan is documented as “Cold spray to the lesion for anesthesia. The lesion was then circumscribed with #15 blade. The keratotic core then excised down to the level of the basement membrane. Bleeding was appreciated, then controlled with compression. No biopsy was performed.” Can I ever bill this as a CPT 11305? with a D23.7? If so, can this be done every 10 weeks?”

“I have a patient who returns to the office for recurrent six intractable porokeratosis. I have treated this situation for the patient about three months previously and I billed CPT code 17110 after treating it with an application of Cantharone. Can I bill CPT 17110 at this second visit?”

“We performed a heel injection on the right foot for a patient with plantar fasciitis. I used CPT 20550 -RT. UnitedHealthcare denied the claim stating we could not prove we injected a substance on a CPT code that requires it. I discussed this with the “MARS” auditor and that was her comment. Any suggestions on why this was denied and how to correct it?”

If a patient that has Traditional Medicare and a secondary coinsurance, when, if ever, is it appropriate or is it payable to bill for a consultation code such as CPT 99243 or CPT 99244?