CPT Codes

“I am looking for a relatively concise explanation regarding Medicare’s policy on palliative care and coverage for diabetics and non-diabetics. As of late, fewer and fewer charges for nail debridement and keratosis debridement are being reimbursed. I have tried to search through Medicare’s guidelines but there is not enough time in a year to sift through the documentation. Is there such a thing as a concise explanation for Medicare’s guidelines for palliative care and CPT codes with ICD-10 codes?”

“I performed a removal of a failed 1st metatarsophalangeal implant and, at the same setting, an arthrodesis. Should I bill for both the removal of the implant and subsequent fusion?”

“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?”

“What is the date that fracture care begins? Is it the date of the injury or is it the date of service when the doctor makes the decision for closed management of a fracture?”

“Has anyone else noticed Novitas is not approving E/M codes for treating onychomycosis medically? I saw a patient for evaluation of a discolored toenail. She was concerned it might be a fungal infection and wanted to treat the condition before it worsened. I obtained an H/P, a specimen for culture and discussed treatment options depending on culture results. I billed CPT 99212 with diagnosis code B35.1. The EOB read $0 payment. Code 49 “These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. Any advice?”

“I performed a partial 1st ray amputation that included the hallux and part of the 1st metatarsal. The site did not heal, and a new infection developed at the amputation site. The result is a return to the operating room for a right trans-metatarsal amputation. For the subsequent surgery, I used Modifier 78. After all, this was an unplanned return to the operating room. I evaluated the patient post operatively and I am wondering which date should I be using for the 90-day global period?”

“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.”

“My practice involves a lot of wound care and I frequently take patients to the operating room for a debridement involving a wound and bone with osteomyelitis. I always code this type of procedure as CPT 11043 and CPT 11044. I feel that this is justified because I am debriding the soft tissue structures (CPT 11043) but also the bone (CPT 11044). I was discussing this with a colleague and she suggested that this might not be appropriate.”

“What code would you recommend for the excision of a pressure ulcer? Here is an excerpt from the operative report: “Attention was directed to the left plantar medical foot at the level of the arch where an approximately 3 cm round chronic ulceration with underlying bursa formation was noted. At this time, an elliptical incision was made in a 3:1 fashion running in line with the foot from toe to heel. This incision was deepened through subcutaneous tissues with care being taken to identify and retract all vital neurovascular structures. At this time, dissection scissors were utilized in order to remove the chronic ulceration with underlying bursa. The skin margins were then separated in order to free up and allow for skin closure.”