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Billing

Coding

What is the Appropriate Documentation for the Debridement of a Non-Pressure Ulcer?

by Dr. Michael Warshaw, DPM, CPC

Medical Record Documentation 1. Indicate the size, depth, grade, and appearance of the wound or ulcer. This is done on every encounter.   2. Indicate the type of tissue or material removed from the wound or ulcer. The tissue or material must be necrotic. This is the sole factor that determines the debridement code to bill. The selected debridement code is based upon the deepest level of necrotic tissue that is excisionally debrided from within the ulcer. 3. Chart the location of the wound or ulcer. This is the only time in the entire process that the location is stated.   4. Indicate any anesthesia (or lack of need) used during the debridement. This is imperative for 11043 or 11044. 5. Indicate any associated status factors that may affect treatment
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Coding

Is it Always Appropriate to Bill CPT Code 13160 for Delayed Closure Following an Amputation?

by Dr. Michael Warshaw, DPM, CPC

A diabetic patient undergoes a transmetatarsal amputation. Due to the infectious process, the surgeon decides to perform delayed closure at point “X” in the future. When the time arrives to close the surgical site, the appropriate wound closure code is billed appended by the 58 modifier. This confirms a documented “staged, related, pre-planned procedure.”
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Coding

What are the Rules and Regulations for Billing for Physical Therapy?

by Dr. Michael Warshaw, DPM, CPC

Physical Therapy: For Calendar Year 2022, the combined outpatient physical therapy and speech language pathology cap is 2,150.00. Physical Therapy is a covered service when that service is medically reasonable and necessary to restore a patient’s level of function that was lost or reduced due to injury or illness. To substantiate medical necessity, there must be a written indication in the medical record regarding the expected improvement. Prior to treatment, a physician must certify the Medical Necessity for the therapy and establish a “Plan of Treatment.”
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Coding

What are the Postoperative Global Periods and What is Included in them?

by Dr. Michael Warshaw, DPM, CPC

Minor Surgery: Any CPT code that has a Global Period of “0” or “10” days is classified as a Minor Surgical Procedure. Major Surgery: Any CPT code that has a Global Period of “90” days is classified as a Major Surgical Procedure.
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Coding

Performing Nail Debridements

by Dr. Michael Warshaw, DPM, CPC

Can an Unlicensed Individual Perform Nail Debridements Under the License of a DPM and Can the Service be Billed to Medicare?
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Coding

IMPLANT vs. FOREIGN BODY

by Dr. Michael Warshaw, DPM, CPC

What are the new rules that went into effect on January 1, 2022 for the removal of hardware? I am not sure whether to bill for the removal of an implant or for the removal of a foreign body. How do you distinguish between an implant and a foreign body?
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Coding

Billing Veruca

by Dr. Michael Warshaw, DPM, CPC

I was discussing with my biller verruca follow-ups. Most of these are #15 blade debridements in the process of reducing the hyperkeratosis and verrucous tissue to allow topical medication to work. With most of these, as I am managing the attempted eradication of the wart, I bill a 99212 (I am a conservative biller). However, you hear colleagues (most of the time it’s not good) talking about using 17110 (Destruction of benign lesion. In its description it states surgical curettement and by destruction I would assume this means removal. So I don’t think 17110 is the appropriate code to bill. What are your thoughts? The other one is 11300, which is shaving benign lesions: Is this appropriate for verruca? I am thinking this is more shaves for biopsies. So, in the end, am I stuck using 99212 for verruca follow-ups such as I have described? Or is there another option?
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Coding

X-Rays Performed in a Podiatrist's Office

by Dr. Michael Warshaw, DPM, CPC

What are the guidelines and documentation requirements for X-rays being performed in a podiatrist’s office?
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Coding

Issues with the Radiology Department

by Dr. Michael Warshaw, DPM, CPC

“My clinic is at the local hospital. I send X-rays to the radiology department. They are eventually read by a radiologist. However, I actually evaluate the x-rays and interpret them myself. Can I bill that component of the radiology fee? And if I do, will it affect radiologist reimbursement?”
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Coding

Routine Foot Care: Cash Clinic

by Dr. Michael Warshaw, DPM, CPC

“I am in practice and would like to figure out a different way to contain and manage my routine foot care. It is approximately 15% of my practice. I would like to designate one morning a week as a routine foot care clinic. I am considering making this a cash only clinic: $50 for toenails and $50 for calluses. Is this possible? I am a Medicare provider and have contracts with most insurance companies. I was hoping to model my cash clinic on what some nurses in the area have done. They visit a nursing home and offer residents $25 for routine foot care and do not work with any insurance companies or Medicare. Any thoughts on this cash model, routine foot care clinic would be appreciated.”
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