CPT

“I often provide wound care for hospice patients and append the GW modifier. However, I recently read that it would be hard to defend this as the wound(s) and wound process is likely related to the patient being deconditioned and malnourished due to their hospice qualifying condition. I am looking for clarification regarding this, should I stop performing wound care services to hospice patients?”

“Here’s the scenario: patient has a chronic ulcer left foot that comes in for regular debridements/wound care. Two weeks ago he has a full thickness ulcer and osteomyelitis at the 2nd toe right foot and I performed a partial amputation of the toe in the office. He comes in for postop check five days later and everything is fine. At his 2nd postoperative visit, I notice a new punctate ulcer plantar 2nd toe with exposed bone and progressing osteomyelitis. I did a prep and debrided the bone at this visit (Yes, authorization was submitted for a more proximal amputation at a future appointment.) I also debrided the wound on his left foot. The question I have is with a multiple modifier order/rule for the debridedment of the ulcer left foot. I billed the visit out as follows: CPT 11044-78,T6 CPT 11042-59,79,LT Should the order of the modifiers with the CPT 11042 be -59,79 or -79,59 (or does this matter?) I have seen coding recommendations that say that the 1st modifier should be the “pricing” modifier and the 2nd modifier should be the “procedure” modifier but I am not sure of this.”

“I am trying to get a handle on the 2021 E/M changes. The question I have is about the defining pathology/diagnosis as “acute” versus “chronic.” This is critical in the portion of the medical decision making. What do the guidelines tell us about these definitions?”

“In the past, it has been postulated that a doctor had the option of using a fracture code or using E/M codes to bill for fracture care. With the upcoming changes to E/M reimbursement, it would seem that billing using E/M codes might make for sense for fracture care. Are there any thoughts on these changes upcoming for 2021?”

“We have billed CPT 11730 for all 10 nails using the appropriate toe modifiers. Anthem Blue Cross paid for five of the toes but is denying the other five. The denial comes back with CO-222 (Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.) Please advise.”

“I am excising a wound on top of the foot (not on the bottom) and opening up to expose a Brodie abscess of the cuboid. Following this, I will be curetting the abscess from the bone to promote bleeding of the bone and filling it with an allograft bone putty impregnated with antibiotics. I am considering using these following CPT codes 28107 and CPT 15999. Is CPT 15999 correct to use for a wound on top of the foot? "

“Can someone please clarify the postoperative global period for a percutaneous flexor tenotomy for flexible hammertoes? I thought the postop global for CPT 28010 was ten days. I discovered that it is 90 days! Is it really the same as a bunion correction? I performed an in office flexor tenotomy successfully on one foot and now the patient requests correction for the other foot. I understand how a longer global period would discourage so called “serial surgeries” for higher reimbursements for multiple procedures on one foot. But on the opposite foot as well?”

“A friend of mine is encouraging me to change how I bill for my Lapidus bunionectomy. I typically bill this using CPT code 28297. I am being told that I should think about billing this “alternatively” as: 1) CPT 28740 2) CPT 28292 Thoughts on this?”

“I have a patient who will undergo a Cartiva implant procedure for hallux limitus/rigidus at the 1st metatarsophalangeal joint. He also has lateral deviation of his hallux on the same foot and an Akin osteotomy will be performed to address this deformity. Should the Akin osteotomy be billed as a separate procedure or is that considered unbundling?”

“We are having difficulty with a denial when combining CPT 28320 and CPT 20680. CPT 20680 is being rejected as unbundling. According to CCI edits, CPT 28320 is a Column 1 code and CPT 20680 is a Column 2 code and they are allowed. The surgeon removed hardware from a prior surgery performed by a different surgeon not associated with the practice then repaired a non-union and applied new fixation. Is the removal of prior hardware actually included in CPT code 28320? If not, what modifier should be used if it is the same incision/surgical site as the non-union repair?”