CPT Codes

“What constitutes the difference between CPT 10120 and CPT 10121 – simple subcutaneous versus complicated subcutaneous foreign body removal? Take for example a patient is seen in the clinic with a splinter that I was unable to retrieve simply. Instead, it required local anesthesia and deep probing but no incision or suturing. I removed a 2 centimeter wood splinter. It was subcutaneous, it was “more complicated” than a typical splinter to retrieve (needing local and more than usual probing) yet really wasn’t THAT complicated. How do you define complicated in this case? RVU values for CPT 10121 versus CPT 10120 seem to indicate there are very real differences between the two codes.”

“I have a patient who returns to the office for recurrent six intractable porokeratosis. I have treated this situation for the patient about three months previously and I billed CPT code 17110 after treating it with an application of Cantharone. Can I bill CPT 17110 at this second visit?”

“We performed a heel injection on the right foot for a patient with plantar fasciitis. I used CPT 20550 -RT. UnitedHealthcare denied the claim stating we could not prove we injected a substance on a CPT code that requires it. I discussed this with the “MARS” auditor and that was her comment. Any suggestions on why this was denied and how to correct it?”

Fractures, Dislocations, Casts, and Splints

What is the most appropriate way(s) to bill for the correction of a hammertoe deformity?

Can a hallux valgus correction CPT code be billed if the medial aspect of the head of the 1st metatarsal is not removed?

A patient had a first metatarsophalangeal joint fusion/arthrodesis performed. Approximately 1 month following the procedure, one of the screws that was used to perform the procedure backed out of the bone and the plate that was applied to the 1st MPJ and started to apply pressure beneath the underlying skin at the site of the surgical incision. The screw needed to be removed. What would be the most appropriate CPT code to bill?

Proper Use of the 59 Modifier

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.

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