CPT

“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 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?”

“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?”

In order to bill 28292, 28295, 28296, 28297, 28298, 28299, the medial aspect of the head of the 1st metatarsal MUST be excised/removed in addition to any additional procedures that are performed to correct the hallux valgus deformity to justify and support the CPT code that is billed.

The AMA has approved significant changes to the 2026 CPT book for Remote Monitoring Codes. If you are providing Remote Therapeutic or Remote Physiologic Monitoring, you need to be aware of these code changes. With these changes the burden associated with Remote Monitoring is reduced and you may want to look at incorporating Remote Monitoring into your practice.

“I saw a patient at the wound care clinic, and he presented with an abscess that required urgent incision and drainage. I sent him directly to the emergency room for admission, work-up for sepsis and later that evening performed an incision of the 3rd intermetatarsal space, bone biopsy of the third metatarsal and application of a wound vac. I followed him while he was admitted. I am not sure how to code the initial visit in the wound care clinic. I am not sure about modifiers for the “decision for surgery.” Can I bill for the subsequent daily rounding and changes of the VAC while he was admitted? Could you please advise the proper billing?”

“I saw an established patient who returned to the office for Routine Foot Care. The patient also had a new complaint of heel pain. I obtained X-rays of the foot and gave a steroid injection into the heel. Can I bill for the Routine Foot Care and those treatments as well?”

“If a Medicare patient is seen in the emergency department and then surgery is performed later that day or night, can the emergency department consult be billed with a modifier -57 along with the surgery? We have been under the impression that, at least in the office, the visit to decide to do the surgery is included in the surgical fee. Are we correct and does this apply to the encounter in the emergency department too?”

“I have been getting insurance denials for subsequent billing of CPT code 11042 after one has been previously performed. Regardless of what level of tissue is debrided, my biller is saying I can only bill CPT code 11042 every 60 days. The biller is telling me that if I debride any level of tissue within those 60 days, I should bill CPT code 97597 until 60 days have passed. Then after 60 days, I can bill CPT code 11042. This does not seem appropriate. Should we appeal?”