Coding

What are the new rules that went into effect on January 1, 2022 for the removal of hardware? I am not sure whether to bill for the removal of an implant or for the removal of a foreign body. How do you distinguish between an implant and a foreign body?

I was discussing with my biller verruca follow-ups. Most of these are #15 blade debridements in the process of reducing the hyperkeratosis and verrucous tissue to allow topical medication to work. With most of these, as I am managing the attempted eradication of the wart, I bill a 99212 (I am a conservative biller). However, you hear colleagues (most of the time it’s not good) talking about using 17110 (Destruction of benign lesion. In its description it states surgical curettement and by destruction I would assume this means removal. So I don’t think 17110 is the appropriate code to bill. What are your thoughts? The other one is 11300, which is shaving benign lesions: Is this appropriate for verruca? I am thinking this is more shaves for biopsies. So, in the end, am I stuck using 99212 for verruca follow-ups such as I have described? Or is there another option?

What are the guidelines and documentation requirements for X-rays being performed in a podiatrist’s office?

“What diagnosis code should be used for CPT 11719, NON-dystrophic toenail debridement?”

“I have a simple question for which I have not been able to find the correct answer. I have a Medicare patient whom we took to the operating room to remove 3 skin lesions. Two were removed from the left foot and one was removed from the right foot. We used code CPT 11421 and are planning on billing the following way: CPT 11421 – 50 (2 units, one lesion on the LT and one the RT) CPT 11421 – LT (the other lesion on the LT) I checked CCI edits and it says I do not need to use a 59 modifier but I feel like I should. Some people have said to use XS modifier. Some have said to bill one code 3 units and others to bill 11421 3 times. What’s the correct answer?”

“I am in practice and would like to figure out a different way to contain and manage my routine foot care. It is approximately 15% of my practice. I would like to designate one morning a week as a routine foot care clinic. I am considering making this a cash only clinic: $50 for toenails and $50 for calluses. Is this possible? I am a Medicare provider and have contracts with most insurance companies. I was hoping to model my cash clinic on what some nurses in the area have done. They visit a nursing home and offer residents $25 for routine foot care and do not work with any insurance companies or Medicare. Any thoughts on this cash model, routine foot care clinic would be appreciated.”

“I have a rheumatoid patient with a grossly deformed interphalangeal joint with significant osseous malformations leading to a chronic ingrown toenail on the hallux fibular border. I have ruled out any infection, osteomyelitis, or neoplasm. The bone is grossly hypertrophic and needs excision along with the nail structures on the fibular border. There also may need to be some plastic closure performed. What are the appropriate ICD10 and CPT codes reflective of this scenario?”

“Is the debridement of a plantar keratosis (CPT 11055) at the first metatarsal head considered bundled with nail debridement (CPT 11720)?”

“I just received a letter from Cigna insurance. As of August 13, 2022, they will require the submission of office notes with claims submitted with Evaluation and Management/E and M codes (ie. 99212, CPT 99213, CPT 99214) appended by modifier -25 when a minor procedure is also billed the same day by the same physician. The E/M will be denied if documentation is not received. The claim can be sent electronically with attachment indicator and notes should be faxed. Is this happening with other insurance companies? The amount of paperwork for a small office is crazy and along with continued decreasing reimbursements, higher prices for supplies, shortages, etc. The insurance companies are making greater profits than ever. The insurance premiums have increased and out-of-pocket patient billing has become more significant. The system is not right. What can we do? How do we fight back? Please don’t say take cash rather than insurance, it’s not practical in many circumstances. Any thoughts?”

“I have a patient who has Blue Cross insurance. He came in for a matrixectomy on February 8th and returned on February 15th for follow up. I billed CPT 99213 using M79.673 and T81.40XA for the follow up and the claim was denied. Is there another code or modifier that I should include?”