Billing

“I saw a patient with a history of chronic onychocryptosis. On this date of service, he presented with a red, swollen, tender right great toe. I performed an E/M and diagnosed paronychia L03.031 for which I took a culture for a gram stain and culture and sensitivity. I discussed the problem with the patient, prescribed an oral antibiotic and gave him instructions. I billed CPT 99213-25 for this. During the same visit, I addressed hypergranulation tissue L92.9 of the same toe. I treated it by excising the tissue and cauterizing the area with silver nitrate. I billed CPT 17250. I was told that HMO Blue of Massachusetts retracted the office visit due to an audit and that there are no appeal rights. Insurance states that “there are no other issues managed and treated aside from the procedure. Therefore the documentation does not support a separate E&M level of service.” I would appreciate any insights you have on this situation, especially when I am informed that I have no appeal rights.”

“We have been finding that, just recently, United Healthcare has a problem with the combination of CPT 64450 and CPT 76942. They are paying the CPT 76942. We have appealed with medical records and CPT 64450 still being denied. We have resubmitted with a 59 and are waiting on response. Is anyone else experiencing the bundling of these two codes?”

“Can anyone please explain the CPT codes for retrocalcaneal surgical treatment? Specifically, the combination of codes that can billed for this pathology. 1. Secondary repair of Achilles tendon 2. Resection of a Haglunds deformity 3. Resection of posterior calcaneal spur.”

“Can one appropriately bill a debridement code, such as CPT 11042, each time when applying a skin substitute if indicated in a hospital, outpatient wound care clinic?”

“I performed a removal of a failed 1st metatarsophalangeal implant and, at the same setting, an arthrodesis. Should I bill for both the removal of the implant and subsequent fusion?”

​​​​​​​“I saw a patient on March 20, 2020 with a new, mildly displaced 3rd metatarsal fracture (S92.332A). I have been following him since then and have billed Anthem Blue Cross with ICD10 S92.331D and have gotten reimbursed. The last visit I had with the patient was August 17, 2020 and billed Anthem Blue Cross for S92.332S. The claim was denied as Missing/incomplete/invalid principal diagnosis. Isn’t S92.332S a valid primary diagnosis code?”

“We have a disagreement among our group regarding radiology billing. If a new patient presents with x-rays, MRI, etc., from an outside source, without a report (or with an inadequate report), can the podiatrist bill for the professional component of reading the imaging studies provided?”

“I had a patient call me worried about a possible diabetic foot infection. The patient has a history of below the knee amputation at the other limb and was panicked about the potential loss of limb. I worked them into the schedule that day and I am thinking about coding CPT 99058 in addition to the E/M code. Can I get paid for CPT 99058 and does it matter if the potential “infection” turned out to be not infected?”

“My patient suffered blunt trauma to his right hallux and suffered non-displaced fractures of the distal and proximal phalanx. We are going to treat this injury conservatively. Would it be appropriate to bill CPT 28490 two times to represent the treatment of both phalanx?”

“As a general question, I am wondering if a physician documents that the patient has had symptoms for longer than a year and has failed conservative/other treatment, can this problem be considered as “chronic with exacerbation/progression”? I am referring to the verbiage in the CPT book (page 13, under Stable, chronic illness) regarding the expected duration of at least 1 year and am wondering if it is applicable in this scenario. Also, I know that a diagnosis of osteoarthritis is inherently considered “chronic”, but I am wondering if there are other diagnoses that can be considered ‘chronic’, as well?”