The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 MIPS payment year.
“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?”