Medical Coding

“Can anyone offer advice or input for a telemedicine visit? The telemedicine visit was performed to update a history and physical prior to surgery AND it is performed by a medical assistant.”

“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 who suffered an inversion, ankle injury. This injury resulted in a severe sprain of the lateral ankle ligaments and a fracture of the fifth metatarsal. The initial treatment involved immobilization using a CAM boot. I billed an E/M code and CPT 28470 at the initial visit. Eight weeks later the patient is in clinic, the 5th metatarsal fracture has healed clinically and radiographically. However, the ankle ligaments are clinically symptomatic and the patient is complaining of continued ankle instability. This clinic visit was focused on continued treatment of the lateral ankle ligaments and we are considering an MRI for further evaluation. I know I am still in the global period for CPT 28470, but I am still working on this ankle! Can we bill an E/M for this visit?”

“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?”