Coding Pearls

1. Are podiatrists allowed to perform a fall risk exam only in specific cases (in patients over 65, ones with prior history of falling, etc.) or general wellness exam G0438? Question #1: Podiatrists are certainly able to perform an annual fall risk assessment. The Centers for Disease Control and Prevention (CDC) and the American Geriatric Society recommend yearly fall assessment screening for all adults 65 years of age and older. If the screening shows you are at risk, you may need an assessment.  A fall risk assessment should be offered to older people who have had one or more falls in the past year or demonstrate abnormalities of gait and/or balance.

“Can ‘At Risk,’ Routine Foot Care be billed for a patient that has evidence of neuropathy, no vascular impairment and no Class findings?”

“Medicare DMERC B jurisdiction has stopped abruptly allowing and paying for L3010 using RT KX and LT KX. I cannot find any information about new modifiers or other info needed. Any suggestions? I do accept Medicare assignment.”

“The original procedure that was performed was a hallux interphalangeal joint arthroplasty to resolve a medial, diabetic ulcer. An infection developed that led to a hallux amputation. Does the global of the first surgery (arthroplasty) stay in place or is it reset by the zero-day global for the second surgery (amputation)?”

A claim for orthotics, L3000 right and L3000 left is being sent to Care-First Blue Cross Blue Shield Washington DC. Question: is Place of Service still #12 (Home)? I ask because a claim was recently denied for POS 12 for orthotics (too early to know if changing it to Place of Service 11 for Office was successful.

“I do some part time work in a wound care center. I frequently use CPT 97597 for coding. My biller is telling me not to bill CPT 97597 because it reimburses around $25 or less in a wound care center. However, the facility likes and even encourages me to use CPT 97597. If I do a selective debridement, can I bill CPT 99213 or CPT 99212 instead of CPT 97597? I know that I should not bill CPT 99213-Modifier 25 if there isn’t a separate complaint. Am I required to bill 97597? Is this a scenario that I should be considering CPT 11042?”

“After watching some E/M presentations, it was suggested that hospital consultations should be billed with CPT 99252-CPT 99255. When we billed these codes, our EMR system and our clearing house rejected the codes. They are saying effective 1/1/2010, CMS has announced that they will reject codes. Are we billing the right codes?”

“I have a patient who had a bunionectomy. The patient was diagnosed with a post- operative infection within the global period which required evaluation and management. I billed Medicare for an office visit, but Medicare will not pay. What am I doing wrong? I used 24 as a modifier.”

“I have a patient with a possible 1st proximal phalanx cyst vs infection that I plan to do an exploratory procedure and collect some bone cultures / swabs on. MRI was inconclusive. If I get in there and the bone appears necrotic/infected, I will have on the consent form to allow for a PIPJ arthroplasty. So, we'll get prior auth for all these procedures prior to surgery. But, for the initial planned procedure, how would this be coded?”

Overuse of skin substitutes (CTPs) to help heal wounds/ulcers has especially come under fire in recent years. Medicare spent more than $10 BILLION on these products in 2024 – more than DOUBLE what was spent the year prior.