Postoperative

“A Medicare patient is admitted to the hospital for a foot infection and suspected osteomyelitis of the left, fourth toe. Amputation of the toe is done at the metatarsophalangeal level and billed CPT 28820-T3. However, post-operative x-rays reveal that there is residual bone, presumably from the base of the proximal phalanx that remains. The patient is taken back to surgery a few days later for removal of the residual bone. This was done during the same hospitalization. Would this be coded as CPT 28124-78? Would the -78 modifier not apply since there is no global for the amputation? Could CPT 28124 be billed without a modifier?”

“Here’s the scenario: patient has a chronic ulcer left foot that comes in for regular debridements/wound care. Two weeks ago he has a full thickness ulcer and osteomyelitis at the 2nd toe right foot and I performed a partial amputation of the toe in the office. He comes in for postop check five days later and everything is fine. At his 2nd postoperative visit, I notice a new punctate ulcer plantar 2nd toe with exposed bone and progressing osteomyelitis. I did a prep and debrided the bone at this visit (Yes, authorization was submitted for a more proximal amputation at a future appointment.) I also debrided the wound on his left foot. The question I have is with a multiple modifier order/rule for the debridedment of the ulcer left foot. I billed the visit out as follows: CPT 11044-78,T6 CPT 11042-59,79,LT Should the order of the modifiers with the CPT 11042 be -59,79 or -79,59 (or does this matter?) I have seen coding recommendations that say that the 1st modifier should be the “pricing” modifier and the 2nd modifier should be the “procedure” modifier but I am not sure of this.”

“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?”