Coding

“What would be the best code or codes to represent an acute, ruptured plantar fascia?"

“My partner prefers to inject the subtalar joint under fluoroscopy. What would be the best procedure code to bill for an injection of the subtalar joint and does the use of fluoroscopy change things?”

“For Medicare, it has been well established that debridement for callouses is not covered when class findings are not present. But what about that patient that complains of pain from a callus. If you evaluate the painful callus and manage the painful callus, would it not be appropriate to bill a low level E/M code? This patient does not want surgery but this is a recurring problem. Can the E/M be billed each time the patient is seen?”

“What procedure codes represent the treatment of an abrasion? Are we restricted to E/M codes?”

“I am part of a recovery audit from CMS for using a modifier 59. Cotiviti Healthcare has been hired by CMS to review my use of modifier 59. They stated that my operative report supports documented Charcot reconstruction and the use of application of external fixator (CPT 20692) but modifier 59 was inappropriately used since both procedures were performed at the same session. Should I have used a different modifier in this situation? Is application of an external fixator (CPT 20692) not considered a separate procedure if it is performed at the same session as other reconstruction procedures?"

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

“In the summer of 2021, when the delta variant was near its peak, I attempted a house call visit to review laboratory results and discuss treatment options. The family of the elderly patient did not want anyone in the house and recommended leaving the results and instructions at the front door. Lab results, my interpretation of the results, prescription and instructions were left at the front door as instructed. This, of course, required driving to the patient’s residence to accomplish this. How could this scenario be billed to Medicare?”

What E/M code would you bill for initial evaluation at an “inpatient” acute care facility in a long term, rehabilitation unit? What “place of service” would you use?

“I received notice I am being selected for a TPE (targeted probe & education) review by Novitas Medicare. I practice in New Jersey. I have gone over the LCDs and the “educational” materials they sent. My documentation seems to be aligned with what they want. Any advice for working with them to have this resolved as soon as possible? Any things to avoid? Should I have someone other than myself act as a liaison between Medicare and me?”

“Is there a foolproof way to deal with the “Medicare doesn’t cover orthotics” issue? Is there an article that explains to the irate patient on the difference between functional orthotics and diabetic insoles and what is covered by Medicare? In this scenario, we typically explain to the patient that orthotics for plantar fasciitis are not covered. We have them sign an ABN and we can easily send the L3000 into Medicare with the GY modifier. We can share this with the patient and they can see that it is not covered. However, what can we do when the patient calls Medicare themselves and are told that orthotics are covered?”