Surgery

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.

“I have a rheumatoid patient with a grossly deformed interphalangeal joint with significant osseous malformations leading to a chronic ingrown toenail on the hallux fibular border. I have ruled out any infection, osteomyelitis, or neoplasm. The bone is grossly hypertrophic and needs excision along with the nail structures on the fibular border. There also may need to be some plastic closure performed. What are the appropriate ICD10 and CPT codes reflective of this scenario?”

“Can anyone please explain the CPT codes for retrocalcaneal surgical treatment? Specifically, the combination of codes that can billed for this pathology. 1. Secondary repair of Achilles tendon 2. Resection of a Haglunds deformity 3. Resection of posterior calcaneal spur.”

“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?”

“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?”

“On February 11, a patient has a transmetatarsal amputation. The patient is a non-compliant, diabetic. The site deteriorates weeks after he leaves the hospital. On March 24, he was readmitted for an infected at the amputation site. On March 26, the remaining 5 metatarsals stumps are removed, and the wound is kept open. How would you recommend coding for the 2nd surgery? What is the code for removing the 5 remaining metatarsal stumps?”

“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.”

“I have a patient who will undergo a Cartiva implant procedure for hallux limitus/rigidus at the 1st metatarsophalangeal joint. He also has lateral deviation of his hallux on the same foot and an Akin osteotomy will be performed to address this deformity. Should the Akin osteotomy be billed as a separate procedure or is that considered unbundling?”

“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?”

“I attempted to remove a screw under local anesthesia in the office setting that was placed during a bunion correction about 10 yrs ago. I was unsuccessful and the patient will need to undergo the procedure in the operating room. How would I bill this visit? It was a new patient to the office.”