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CPT Codes

Coding

New Rules for CPT Codes 11730 and 11750

by Michael Warshaw, DPM, CPC

Understand the new utilization parameters and documentation requirements for CPT Codes 11730 and 11750.
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Coding

What are the Postoperative Global Periods and What is Included in them?

by Dr. Michael Warshaw, DPM, CPC

Minor Surgery: Any CPT code that has a Global Period of “0” or “10” days is classified as a Minor Surgical Procedure. Major Surgery: Any CPT code that has a Global Period of “90” days is classified as a Major Surgical Procedure.
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Coding

Diagnosis Code for CPT 11719

by Dr. Michael Warshaw, DPM, CPC

“What diagnosis code should be used for CPT 11719, NON-dystrophic toenail debridement?”
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Coding

Baffled With Bilateral Biopsy

by Dr. Michael Warshaw, DPM, CPC

“I have a simple question for which I have not been able to find the correct answer. I have a Medicare patient whom we took to the operating room to remove 3 skin lesions. Two were removed from the left foot and one was removed from the right foot. We used code CPT 11421 and are planning on billing the following way: CPT 11421 – 50 (2 units, one lesion on the LT and one the RT) CPT 11421 – LT (the other lesion on the LT) I checked CCI edits and it says I do not need to use a 59 modifier but I feel like I should. Some people have said to use XS modifier. Some have said to bill one code 3 units and others to bill 11421 3 times. What’s the correct answer?”
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Coding

Issues with the Radiology Department

by Dr. Michael Warshaw, DPM, CPC

“My clinic is at the local hospital. I send X-rays to the radiology department. They are eventually read by a radiologist. However, I actually evaluate the x-rays and interpret them myself. Can I bill that component of the radiology fee? And if I do, will it affect radiologist reimbursement?”
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Coding

Complicated Toenail Surgery

by Dr. Michael Warshaw, DPM, CPC

“I have a rheumatoid patient with a grossly deformed interphalangeal joint with significant osseous malformations leading to a chronic ingrown toenail on the hallux fibular border. I have ruled out any infection, osteomyelitis, or neoplasm. The bone is grossly hypertrophic and needs excision along with the nail structures on the fibular border. There also may need to be some plastic closure performed. What are the appropriate ICD10 and CPT codes reflective of this scenario?”
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Coding

Injection Denials

by Dr. Michael Warshaw, DPM, CPC

“I have been getting denials from BCBS, First Care, Aetna, and UHC on claims billed out with diagnosis codes M72.2, M71.571, M71.572, M77.31, and M77.32. Has anyone else had this problem lately? The NDC number and the description are on the claim. The claim is going out as follows: CPT 99213 25, CPT 20550 RT, CPT 20550 LT, J0702 x 2 units, J1030 x 2 units.”
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Coding

Matrixectomy Follow Up

by Dr. Michael Warshaw, DPM, CPC

“I have a patient who has Blue Cross insurance. He came in for a matrixectomy on February 8th and returned on February 15th for follow up. I billed CPT 99213 using M79.673 and T81.40XA for the follow up and the claim was denied. Is there another code or modifier that I should include?”
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Coding

Combination of Services

by Dr. Michael Warshaw, DPM, CPC

“Is a plantar keratosis debridement (CPT 11055) at the first metatarsal head considered bundled with nail debridement (CPT 11720)?”
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Coding

Replacement Device Challenges

by Dr. Michael Warshaw, DPM, CPC

“We had a patient that was dispensed an ankle foot orthoses (AFO) about 4 1/2 years ago. This device broke and he was having difficulty walking without it. We dispensed a new AFO and it was denied as the original wasn’t 5 years old. We had a very long telephone conversation with Medicare along with the patient and his attorney. Unfortunately, Medicare wouldn’t budge as they said he should have gone back to the provider of the original brace, even though it was in another state. We did have an ABN, but the patient said that he’s not going to pay for the replacement. We are working with him now to at least get our lab costs. Unfortunately, appeals don’t always work. We requested a peer-to-peer, but after several months we have not heard anything as they are too backlogged! I suspect that there are other stories like this out there. I wish we could just tell patients what it costs and they hand over their credit cards.”
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