CPT

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?”

“We have had an influx of phone calls that are burdening our clinical hours. We have been flooded with questions that pertain to patient care, clarification of orders and home care instructions. Is there a way to bill for these calls? Each call can take 20-45 minutes for our medical assistants to complete. And we are trying to manage a full clinic at the same time.”

Can I bill for using intraoperative fluoroscopy (C-arm) to assist in hardware placement before, during and after the procedure? The images are all taken while in the operating room. If so, do I need a modifier for the code? Can I use the same CPT for the surgery with the code for the intraoperative x-ray or does it require a different CPT code? Thank you!

“I have a patient with a nonhealing pressure wound on his right ankle and his right heel. I applied a skin graft substitute to both sites. I used a single piece and shared it between the two sites. The ICD 10 code I used for the ankle is L89.513. The ICD 10 code I used for the heel is L89.613. For the application codes I utilized CPT 15271-RT to the L89.513 and CPT 15275-RT to the L89.613. The CCI does not show any conflict, but I am wondering whether a -51 is necessary. I also used the correct Q code for the product.”

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