Medical Billing

“My practice involves a lot of routine foot care and I am looking for clarification. In using Q8 and Q9 modifiers, do you need to have atherosclerotic peripheral vascular disease (ASPVD) as a diagnosis? If so what’s the code to be used for general ASPVD? Modifier Q7 indicates that there has been an amputation. It is not necessary to have an ASPVD diagnosis in that scenario?”

“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?”

“Our office has decided to take the leap and do diabetic shoes for patients who see a Nurse Practitioner or a Physician’s Assistant. Has anyone had any luck with this? We are noticing that we are not hearing much about this since earlier this year.”

“Can one appropriately bill a debridement code, such as CPT 11042, each time when applying a skin substitute if indicated in a hospital, outpatient wound care clinic?”

“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?”

“We have a disagreement among our group regarding radiology billing. If a new patient presents with x-rays, MRI, etc., from an outside source, without a report (or with an inadequate report), can the podiatrist bill for the professional component of reading the imaging studies provided?”

“I had a patient call me worried about a possible diabetic foot infection. The patient has a history of below the knee amputation at the other limb and was panicked about the potential loss of limb. I worked them into the schedule that day and I am thinking about coding CPT 99058 in addition to the E/M code. Can I get paid for CPT 99058 and does it matter if the potential “infection” turned out to be not infected?”

“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?”