Coding

“I have recently done bunionectomies on two separate patients with Anthem and received denials. One was a combination of an Austin procedure and an Akin procedure. I billed CPT 28299 -RT. On another patient, I did an Austin procedure and I billed CPT 28296 -RT. Both claims were denied for “inappropriate use of modifier.” I have called the customer service twice and even sent a corrected claim and removed the modifier but claim was still denied. Has something changed with Anthem that I don’t know about?”

“Can anyone offer advice or input for a telemedicine visit? The telemedicine visit was performed to update a history and physical prior to surgery AND it is performed by a medical assistant.”

“I have a patient who suffered an inversion, ankle injury. This injury resulted in a severe sprain of the lateral ankle ligaments and a fracture of the fifth metatarsal. The initial treatment involved immobilization using a CAM boot. I billed an E/M code and CPT 28470 at the initial visit. Eight weeks later the patient is in clinic, the 5th metatarsal fracture has healed clinically and radiographically. However, the ankle ligaments are clinically symptomatic and the patient is complaining of continued ankle instability. This clinic visit was focused on continued treatment of the lateral ankle ligaments and we are considering an MRI for further evaluation. I know I am still in the global period for CPT 28470, but I am still working on this ankle! Can we bill an E/M for this visit?”

“I have a patient that has bilateral ulcers with same depth on both feet, and I billed CPT 11042 -RT and CPT 11042 -LT, -59. Insurance has denied the second procedure as a duplicate. How else does this need to be billed as far bilateral ulcer procedures?”

“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?”