Coding

“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?”

“As a general question, I am wondering if a physician documents that the patient has had symptoms for longer than a year and has failed conservative/other treatment, can this problem be considered as “chronic with exacerbation/progression”? I am referring to the verbiage in the CPT book (page 13, under Stable, chronic illness) regarding the expected duration of at least 1 year and am wondering if it is applicable in this scenario. Also, I know that a diagnosis of osteoarthritis is inherently considered “chronic”, but I am wondering if there are other diagnoses that can be considered ‘chronic’, as well?”

“Outpatient surgery was performed at a surgical center. We billed Blue Cross for CPT 11750 (T5) and CPT 11730 x 3 (T2, T7, T9). But they only paid CPT 11750. And the denial reasons are: ARV – Quantity billed exceeds CMS medically unlikely edits (MUE) limit. Rebill within MUE limit if appropriate. 222 – Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: refer to the 835 healthcare policy identification segment, if present. So my question is, what is the limit to bill for ingrown nail surgery?”

“Since the global period for a toe amputation is now zero days, does that mean I bill for removing sutures in the office when I do a follow up visit in 14 days? Billing for this, seems very uncomfortable to me.”

“I had a patient present to the clinic with multiple, minimally displaced toe fractures. She has Medicare and we are planning to treat all four of these conservatively. When and how do I use CPT code 28510?”

“I have several healthy Medicare patients that have painful calluses. These patients come to my office, sometimes monthly complaining of painful callouses. I understand that Medicare does not cover the routine trimming of calluses in healthy patients. However, I have been billing CPT 99212-13 with the diagnosis codes of L84 (corns and callous), M77.4X (metatarsalgia). The documented management plan for L84 is discussion of moisturizing the feet, not waking barefoot, etc. and then I debride the callus. The documented management plan for metatarsalgia is discussion of metatarsalgia and surgical options, and then I place felt padding in the shoe, or modify the shoe to take pressure off the callus. My patients rarely follow my advice for moisturizing and not going barefoot; so ultimately, the calluses come back. Is this appropriate billing? The treatment I provide is instrumental in preventing a wound or ulceration from occurring (which I also document). Also, it relieves the patient of pain. Is it appropriate to bill an E/M code in lieu of a procedure code if the procedure is not covered?”

“I am having trouble finding an appropriate code to bill for a procedure to remove tophaceous material at a toe. The location was the left 2nd toe. This was performed in the office and a digital block was utilized to obtain anesthesia at the toe. Using a 3mm dermal curette, approximately 1 mL of tophaceous material was removed and a sterile gauze dressing applied. I planned to use ICD-10 M1A-0721. What CPT would be appropriate in this situation?”

“On February 11, a patient has a transmetatarsal amputation. The patient is a non-compliant, diabetic. The site deteriorates weeks after he leaves the hospital. On March 24, he was readmitted for an infected at the amputation site. On March 26, the remaining 5 metatarsals stumps are removed, and the wound is kept open. How would you recommend coding for the 2nd surgery? What is the code for removing the 5 remaining metatarsal stumps?”