Coding

“I am looking for a relatively concise explanation regarding Medicare’s policy on palliative care and coverage for diabetics and non-diabetics. As of late, fewer and fewer charges for nail debridement and keratosis debridement are being reimbursed. I have tried to search through Medicare’s guidelines but there is not enough time in a year to sift through the documentation. Is there such a thing as a concise explanation for Medicare’s guidelines for palliative care and CPT codes with ICD-10 codes?”

“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?”

“Outpatient surgery was performed at a surgical center. We billed Blue Cross for CPT 11750 (T5) and CPT 11730 x 3 (T2, T7, T9). But they only paid CPT 11750. And the denial reasons are: ARV – Quantity billed exceeds CMS medically unlikely edits (MUE) limit. Rebill within MUE limit if appropriate. 222 – Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: refer to the 835 healthcare policy identification segment, if present. So my question is, what is the limit to bill for ingrown nail surgery?”

“Since the global period for a toe amputation is now zero days, does that mean I bill for removing sutures in the office when I do a follow up visit in 14 days? Billing for this, seems very uncomfortable to me.”