CPT

“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?”

“I am a young physician and the practice that I am currently at codes almost all routine foot care patients as the following: 1. Tinea ungium B35.1, 2. Peripheral Vascular Disease (PVD) I73.9, 3. Pain in left toe. Documentation is all the same: “All nails are thickened, discolored, and painful with subungual debris” with CPT 11721. Basically, there is no individual nail documentation and all nails are always painful with PVD. This includes younger, disabled patients who present with some thickened nails. I was under the impression that you have to document individual nails and that pain alone is a qualifying diagnosis for nails, if used as the secondary code. My question is: wouldn’t coding only CPT 11721, with pain and PVD to all toes all the time raise red flags?”

“After watching some E/M presentations, it was suggested that hospital consultations should be billed with CPT 99252-CPT 99255. When we billed these codes, our EMR system and our clearing house rejected the codes. They are saying effective 1/1/2010, CMS has announced that they will reject these codes. Are we billing the right codes?”

“What constitutes the difference between CPT 10120 and CPT 10121 – simple subcutaneous versus complicated subcutaneous foreign body removal? Take for example a patient is seen in the clinic with a splinter that I was unable to retrieve simply. Instead, it required local anesthesia and deep probing but no incision or suturing. I removed a 2 centimeter wood splinter. It was subcutaneous, it was “more complicated” than a typical splinter to retrieve (needing local and more than usual probing) yet really wasn’t THAT complicated. How do you define complicated in this case? RVU values for CPT 10121 versus CPT 10120 seem to indicate there are very real differences between the two codes.”

“How do you code for a hospital consultation when the patient is in the postoperative global period from another surgeon? I was called to the local hospital to see a patient that was transferred for medical treatment for an unrelated condition. He had a transmetatarsal amputation (TMA) performed for apparent osteomyelitis at the other hospital by a different podiatric surgeon. I was consulted to evaluate the TMA site and make recommendations for management. How do I code the diagnosis and E/M for this post-operative consultation?”