CPT

“I have a patient with a nonhealing pressure wound on his right ankle and his right heel. I applied a skin graft substitute to both sites. I used a single piece and shared it between the two sites. The ICD 10 code I used for the ankle is L89.513. The ICD 10 code I used for the heel is L89.613. For the application codes I utilized CPT 15271-RT to the L89.513 and CPT 15275-RT to the L89.613. The CCI does not show any conflict, but I am wondering whether a -51 is necessary. I also used the correct Q code for the product.”

“Medicare pays approximately $40 more for an E/M 99213 versus an injection for a neuroma injection. Can you give the injection and only bill the E/M 99213?”

“A new patient was seen with heel pain. X-rays were taken at an outside facility, and I independently interpreted these and reviewed the labs. Based on medical decision making, I believe I should be coding CPT 99204. The patient had one new, acute problem (previously undiagnosed) and I independently interpreted tests. To me this is a no brainer, but my office staff argues that they believe it should be CPT 99203. Thoughts?"

“My billing team and I have a difference of opinion. If we apply more than one graft, they have been using modifier -76. It is getting paid, but I am not sure that is the appropriate use of the modifier. I just assumed we bill for total units. However, each graft has a unit number. So, if we bill double the units, we need a way to alert the insurance company as to why the units are doubled. This is why we started using the 76 Modifier. Any input would be appreciated.”

“Medicare sent me a letter about 6 months ago saying I bill CPT 11721 too often compared to CPT 11720 and CPT 11719. However, they consistently deny the combination of CPT 11719 and CPT 11720-59. Not just bundled, but deny both codes, altogether. That then leaves me an outlier with a bunch of CPT 11721 counted and all of the CPT 11719 and CPT 11720 denials left out of the calculations. Appeals are denied (and a waste of time and resources for $11). Their CCI indicator is 1, meaning they can be billed together with 59 or X- modifier on the column 2 code (CPT 11720). Is it fraudulent billing to code only CPT 11720 even though I am debriding 1 to 4 nails and trimming the rest? It also pays more with just CPT 11720 since it is otherwise secondary to a less-than-$11 CPT 11719 code. I hate to turn away these patients who have a true need. Recommendations?”

“The patient initially had a gastroc recession at the right lower extremity. Our surgeon performed a debridement procedure of the right foot ulceration. It was performed in the clinic, and we planned to code it as CPT 11042. However, the patient is in the 90-day post op period from the initial surgery that was performed 4 weeks ago. Is a modifier necessary to submit for payment? Is it 79?”

“I have an unusual situation that I am trying to figure out how to code. I had a patient return to the office in the global period after I preformed a 1st metatarsophalangeal joint (MTPJ) arthrodesis. Although, the alignment of the fusion looks good, one of the non-locking screws advanced out of the bone and plate and started to tent the skin at the incision site at three weeks post operative. She is neuropathic and denied any trauma to the area. I removed the screw in the office with local anesthesia. Can I bill for unplanned screw removal in the office?”

“I have a patient who suffered a Lisfranc injury that resulted in nondisplaced fractures of the 1st, 2nd and 3rd metatarsal bases. There was no disruption of the alignment of the midfoot. We decided that conservative treatment was the most appropriate option for the patient and this injury. She was casted using fiberglass. I am planning to code this treatment as CPT 28470 Closed treatment of metatarsal fracture; without manipulation, each. I was using the APMA Coding Resource Center and noticed that there is “MUE 2″ for this code. Does this affect how many metatarsal fractures that I can bill for during this treatment?”

“My group takes “call” at our local hospital, and this necessitates seeing patients in the emergency room (ER) on occasion. We are not all in agreement regarding what E/M codes should be used in this scenario. We have come up with different encounters: 1. A patient seen in the ER. The patient is then discharged to follow up for outpatient care. 2. A patient is seen in the ER and then admitted for continued medical treatment. 3. A patient is seen in the ER and is taken straight to the operating room for surgical treatment. What E/M code series would you recommend using for these different scenarios? Thank you for the help!”

“What is the proper CPT code for percutaneous capsulotomy and tenotomy of metatarsophalangeal joint?”