CPT Codes

“I have a patient who honestly only has three mycotic/dystrophic toenails. This elderly gentleman, with Medicare, returns to the office every 90 days for routine foot care (RFC). According to Medicare guidelines, he does qualify for RFC with his physical examine findings. My question is can I bill CPT 11720 for the debridement of the three dystrophic nails and then CPT 11719 for the trimming of the other seven non-dystrophic toenails?”

“How would you code this? I’m stumped. Operation 1. Attention was directed to the medial aspect of left great toe where an incision was made overlying the interphalangeal joint. The incision measured about 3-4 cm in length, the incision was deepened via sharp and blunt dissection, careful attention paid to all neurovascular structures appropriately retracted as necessary. The incision was carried down to bone, the soft tissue was freed from the medial side of the bone at the IPJ. The long flexor tendon was reflected plantarly. The accessory bone was found on the left and seemed to be adherent to the phalanx. It was removed and sent to pathology. The wound was flushed. C-arm radiograph taken pre and post to be sure that the bone had been removed. It was. The flexor tendon was reapproximated and maintained using 2-0 Vicryl, skin closure with 2-0 Vicryl. 4-0 Prolene. Operation 2. Same, right foot Operation 3. Attention was directed to the ulcer of the left great toe, 2 converging semielliptical incisions made surrounding the ulcer, excised and sent to pathology. There was necrotic tissue and debris within it. This was sent as well. The wound was flushed and closure performed using 2-0 Vicryl, 4-0 Prolene. Operation 4. Same, right great toe The doctor coded it as follows: CPT 28315-50, CPT 11422-TA, CPT 11422-T5.”

“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?”

“Can anyone please explain the CPT codes for retrocalcaneal surgical treatment? Specifically, the combination of codes that can billed for this pathology. 1. Secondary repair of Achilles tendon 2. Resection of a Haglunds deformity 3. Resection of posterior calcaneal spur.”

“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?”

“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?”

“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?”

“What is the date that fracture care begins? Is it the date of the injury or is it the date of service when the doctor makes the decision for closed management of a fracture?”

“Has anyone else noticed Novitas is not approving E/M codes for treating onychomycosis medically? I saw a patient for evaluation of a discolored toenail. She was concerned it might be a fungal infection and wanted to treat the condition before it worsened. I obtained an H/P, a specimen for culture and discussed treatment options depending on culture results. I billed CPT 99212 with diagnosis code B35.1. The EOB read $0 payment. Code 49 “These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. Any advice?”