CPT Codes

A patient had a first metatarsophalangeal joint fusion/arthrodesis performed. Approximately 1 month following the procedure, one of the screws that was used to perform the procedure backed out of the bone and the plate that was applied to the 1st MPJ and started to apply pressure beneath the underlying skin at the site of the surgical incision. The screw needed to be removed. What would be the most appropriate CPT code to bill?

Proper Use of the 59 Modifier

Minor Surgery: Any CPT code that has a Global Period of “0” or “10” days is classified as a Minor Surgical Procedure. Major Surgery: Any CPT code that has a Global Period of “90” days is classified as a Major Surgical Procedure.

“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?”

“My clinic is at the local hospital. I send X-rays to the radiology department. They are eventually read by a radiologist. However, I actually evaluate the x-rays and interpret them myself. Can I bill that component of the radiology fee? And if I do, will it affect radiologist reimbursement?”

“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?”

“I have been getting denials from BCBS, First Care, Aetna, and UHC on claims billed out with diagnosis codes M72.2, M71.571, M71.572, M77.31, and M77.32. Has anyone else had this problem lately? The NDC number and the description are on the claim. The claim is going out as follows: CPT 99213 25, CPT 20550 RT, CPT 20550 LT, J0702 x 2 units, J1030 x 2 units.”

“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?”

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