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Documentation

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

Symptomatic Pathologic Nails

by Dr. Michael Warshaw, DPM, CPC

Routine Foot Care, which includes trimming or debridement of the asymptomatic dystrophic, mycotic, or normal toenails is covered by Medicare only when the patient has one of the Medicare-specified systemic diseases with clinically significant peripheral complication placing the patient “at risk” for infection and/or injury if a non-professional attempts to trim or debride the nail. However when the nail becomes ingrown, and the surrounding soft tissue is complicated by pain or inflammation, then its care is no longer “routine,” but involves a pathological state. This state is characterized by one or more of the following: pain, inflammation of the nail bed, inflammation of the surrounding soft tissue, infection and/or abscess.
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Coding

What is the Appropriate Documentation for the Debridement of a Non-Pressure Ulcer?

by Dr. Michael Warshaw, DPM, CPC

Medical Record Documentation 1. Indicate the size, depth, grade, and appearance of the wound or ulcer. This is done on every encounter.   2. Indicate the type of tissue or material removed from the wound or ulcer. The tissue or material must be necrotic. This is the sole factor that determines the debridement code to bill. The selected debridement code is based upon the deepest level of necrotic tissue that is excisionally debrided from within the ulcer. 3. Chart the location of the wound or ulcer. This is the only time in the entire process that the location is stated.   4. Indicate any anesthesia (or lack of need) used during the debridement. This is imperative for 11043 or 11044. 5. Indicate any associated status factors that may affect treatment
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Coding

Documentation Requirements for CPT 11721 continued

by Dr. Michael Warshaw, DPM, CPC

“I am trying to educate my physician about the documentation requirements for CPT 11721. He doesn’t think it’s important to document the number of nails debrided or even the method of debridement. Is there a resource you can point me to that specifically addresses this?” This was addressed last week. “Since it is stated – CPT 11721: Debridement of nail(s) by any method(s); 6 or more, why would it be necessary to document what instruments were used for debridement since any method would be accepted under this description?” This is part 2.
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Coding

Documentation Requirements for CPT 11721

by Dr. Michael Warshaw, DPM, CPC

I am trying to educate my physician about the documentation requirements for CPT code 11721. He doesn’t think it’s important to document the number of nails debrided or even the method of debridement. Is there a resource you can point me to that specifically addresses this?
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CMS Updates

CGS announces Widespread Post-Pay Service Specific Review

by Dr. Michael Brody, DPM, CEO TLD Systems

CGS's Medical Review staff will be conducting a complex post-pay service-specific medical review of HCPCS Codes L1902; L1906; L1971; L4396; L4397 (Ankle-Foot Orthosis). This review will be conducted because data analysis revealed that Jurisdiction B's allowed dollars for HCPCS Codes L1902; L1906; L1971; L4396; and L4397 were significantly above expected amounts. Additionally, the Orthotics policy group ranked #1 in total CERT errors.
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