Medical Coding

“We have billed CPT 11730 for all 10 nails using the appropriate toe modifiers. Anthem Blue Cross paid for five of the toes but is denying the other five. The denial comes back with CO-222 (Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.) Please advise.”

“I am excising a wound on top of the foot (not on the bottom) and opening up to expose a Brodie abscess of the cuboid. Following this, I will be curetting the abscess from the bone to promote bleeding of the bone and filling it with an allograft bone putty impregnated with antibiotics. I am considering using these following CPT codes 28107 and CPT 15999. Is CPT 15999 correct to use for a wound on top of the foot? "

“In a nursing home, if you are rendering a service where the E/M is a systemic condition and separately identifiable, can you bill the E/M code and the procedure? I believe you cannot. My biller and a webinar speaker both feel that you can. Their thought is that as long as you have different diagnoses for the office/nursing home visit and routine foot care, it will be allowable. For example, you could bill E/M 99307, CPT 11056, and CPT 11721 and the diagnosis codes are G20 (Parkinsons), L84 (corns and calluses), I73.89 (PVD), B35.1 (mycotic nails), M79.674 and M79.675 (pain toes). I would put the G20 on the E/M 99307, L84 and I73.89 on CPT 11056 and B35.1 and M79.674, M79.675 on CPT 11721. Any thoughts on this issue would be helpful.”

“This past summer, one of my patients who was suffering from a diabetic foot ulcer was admitted to a skilled nursing facility (SNF) following a hospital discharge. During her admission to the SNF, I continued to care for her in my office, including ulcer debridement and radiographs. Medicare is denying payment for her ulcer debridements (CPT 97597) as well as the technical component of her radiographs (CPT 73630-TC) on the grounds that “all SNF Part A inpatient services are paid under a prospective payment system (PPS)” and that “services that are considered within the scope or capability of SNFs are considered paid in the PPS rate.” In other words, Medicare considers the care that I rendered to be bundled with the payment to the SNF for admission, and therefore the SNF should have been doing it themselves, and that if I want payment I need to bill the SNF since they–in Medicare’s view–outsourced the ulcer care to me. While I fully expect the SNF to balk at any requests for payment from me, and I believe it might still be worth my time to appeal to an Administrative Law Judge, I would like to know if anyone has experienced this? In the future, if I am going to care for the ulcers of my patients when they are admitted to SNFs, is there anything I can arrange with the SNF or with the patient to ensure I am compensated for their care?”

“Can someone please clarify the postoperative global period for a percutaneous flexor tenotomy for flexible hammertoes? I thought the postop global for CPT 28010 was ten days. I discovered that it is 90 days! Is it really the same as a bunion correction? I performed an in office flexor tenotomy successfully on one foot and now the patient requests correction for the other foot. I understand how a longer global period would discourage so called “serial surgeries” for higher reimbursements for multiple procedures on one foot. But on the opposite foot as well?”

“All the nails were trimmed in length with a sterile nail nipper. The leading edges were debrided with the nail bur and electric podiatry drill. The debris under the edges of the great toenails was derided with the sterile curette. Is this nail trimming (CPT 11719) since we DID NOT debride the entire nail (just edges and under toe) or can we bill as CPT 11721?”

“A friend of mine is encouraging me to change how I bill for my Lapidus bunionectomy. I typically bill this using CPT code 28297. I am being told that I should think about billing this “alternatively” as: 1) CPT 28740 2) CPT 28292 Thoughts on this?”

“I am reading conflicting information regarding the dispensing of a post-operative/cast shoe. Medicare never seems to pay for this but commercial carriers usually do. I am reading that this shoe is NOT separately payable when it is dispensed in conjunction with a surgical procedure code. You cannot have the patient sign an ABN and charge the patient for the shoe. Please clarify the dos and don’ts of using the L3260 HCPCS code.”

“We are having difficulty with a denial when combining CPT 28320 and CPT 20680. CPT 20680 is being rejected as unbundling. According to CCI edits, CPT 28320 is a Column 1 code and CPT 20680 is a Column 2 code and they are allowed. The surgeon removed hardware from a prior surgery performed by a different surgeon not associated with the practice then repaired a non-union and applied new fixation. Is the removal of prior hardware actually included in CPT code 28320? If not, what modifier should be used if it is the same incision/surgical site as the non-union repair?”

“Can CPT code 29580 (strapping – Unna’s boot) be used for ICD code M65.871(2) in lieu of CPT code 29540? If not, what is the best ICD 10 code for CPT 29580?”