Coding

“My documentation for qualified, routine foot care is similar for most patients as little changes in 3 months. But, yes, I do look for changes and make the note reflect such. And I try to make sure notes are not exact copies of previous notes. My notes have plenty of bullet points for an E/M code on each visit. I am primarily charging procedure codes only (CPT 11056, CPT 11721, etc). Can I still bill at least one E/M code per year even when there are no substantive changes as I continually monitor vascular, neurologic and dermal changes each visit? Must I have a new or different diagnosis to bill an E/M code?”

“I know things have changed a little for removal of retained hardware and I am seeking clarification for a scenario. A patient has previously had an Austin Akin bunionectomy. It healed uneventfully. Years later, she has developed pain at the retained screw in the metatarsal. There is a k-wire noted in the proximal phalanx. X-rays showed complete healing at the osteotomies. The patient would like to have both implants removed despite only one of them hurting today. How would the changes in CPT coding apply to this situation? Thank you for the help.”

“So, to be clear you can never use L3000kx for a diabetic with neuropathy and diabetic ulcers even if secondary will pay.”

“I have a patient who had a chevron bunionectomy performed 10 years ago. The bunion has returned, and the head is facing lateral. My plan is to perform a Lapidus procedure to reduce the first intermetatarsal angle and a rotational 1st metatarsal head osteotomy to align the articular surface (basically an Austin with a medial based wedge removed from the dorsal osteotomy to rotate the head slightly medial). How would you recommend I code this (ICD-10 and CPT codes)? Can I use CPT 29297 and CPT 29296? I’ve also considered CPT 28740 with CPT 29296.“

“Medicare pays approximately $40 more for E/M code 99213 versus an injection for a neuroma. Can you give the injection and only bill the E/M 99213?”

“I am wondering if any other podiatry practices are having issues with Aetna Medicare getting paid for CPT 11730? The denial of the claims focusses on “LCD guidelines.” We are sending numerous appeals along with medical documentation and the actual article from Medicare (L34887).”

“In many cases requiring an arthroplasty of the proximal interphalangeal joint (PIPJ) 5th digit (especially when associated with a heloma molle), I often do an arthroplasty PIPJ, flexor lengthening and a partial syndactylization (advancing the webspace but differently than the description of Ruiz-Mora). I have always simply billed for an arthroplasty PIPJ 5th toe. Now I have been forced to pay attention to coding because of my EMR program. Should I have been billing this differently for all these years?”

“Can you describe what is a “sufficiently detailed exam” to confirm the diagnosis of peripheral arterial disease? I was audited and the debridement of calluses were denied even documentation of every single class finding were listed. Are we supposed to do ankle brachial indexes, Buerger’s test, etc.? Why have class findings if they do not qualify as “sufficiently detailed?”

“I billed A5500 and A5512 with modifiers -KX, -RT, -LT. L1940 KXRTLT L2330 KXRTLT L2820 KXRTLT I billed these on separate lines. This claim was rejected so we re-billed putting the KX modifier in the 3rd spot and it was still rejected for the same reason. The comment was: 4 – the procedure code is inconsistent with the modifier used or a required modifier is missing Any thoughts on how to tackle this denial?”

If our provider does multiple Tenotomy procedures on one visit on different toes what are the appropriate procedure codes and modifiers to bill correctly? We have been billing 28010 with the "T" modifier and no other modifiers per the provider's request. I feel like we should be adding a "51" modifier on all lines except the first. I would love assistance with this.