Coding I
& D of Abscess
(Volume
108)
The
Question:
Gayle,
Would you please explain to me how these can and
cannot be used in a podiatry setting.
We gave been told that 10080 is not an allowable code
with Medicare. Any other one we could use?
Thanks for your help!
Jenny Wood
Executive Vice President
Wood Medical Billing Medical Professional Resources
The
Answer:
10080 is
incision and drainage of a Pilonidal cyst. I
would recommend using 10060- incision and drainage of
abscess. In the CPT book you will see that this
includes essentially everything we see in Podiatry
that needs to be I&D'd.
Scott Schroeder, DPM
Wenatchee, WA
Coding Bilateral
Procedures and Bilateral Orthotics
(Volume
108)
The Question:
Hi Gayle,
As per your advice, I visit FZ site often. It
has
helped me learn a lot. But I need more help in
understanding the appropriate use of modifiers:
1. For Bilateral procedures, ins. either denies or
pays
half on the second procedure. Certain procedures
like 20550,
11750 do not qualify for modifier -50 so we billed
them with RT/LT modifier or T modifier but still got rejected.
11750 was
done on both lateral and medial borders so we added
modifier
-51 for multiple procedures (with unit of service 2)
but that
caused confusion too.
2. Similarly for bunion surgery(28113 rt/lt) do we
need
to use any modifier?
3. For orthosis (L codes), do we need a modifier to
get
paid since that is always bilateral?
Please advice.
Regards,
SG
The Answer:
Bilateral procedures typically pay half for the second
procedure. Different insurance companies may
handle these differently on how they want you to bill
them to get paid. I would recommend calling your
provider representative from the particular insurance
company you are having problems with and ask them
directly how to get paid for work your doctor has
done. If you want to play darts and just keep
taking stabs at it to see if you get paid you can try
the following: If the right and left, and T
modifiers are not working try the -59 modifier which
means different site. We use this on our
multiple surgical procedures and have had very few
problems. This holds true for injection codes
too. L codes such as L3030 or L3000 are per
"each" foot. They should be billed
with a right and left modifier and never be billed as
a "pair". Example- if your price for a
pair of orthotic devices is $250 you would bill
L3000-RT for $125 and L3000-LT for $125.
Scott Schroeder, DPM
Coding
Corns and Calluses
(Volume
108)
The
Question:
This is my
first time accessing your web site. I am needing any
coding information possible in regards to the trimming
of corns or callosities (11055 11057) when billing
Medicare Part B in the state of Tennessee.
Is it covered under any circumstances, and how to
bill?
Your help will be greatly appreciated.
Caryl McCartt
The Answer:
For the Fine
State of Tennessee I would recommend you contact your
Medicare provider representative (yes- they are
supposed to have them everywhere but many offices do
not know they exist) Contact your regional
Medicare carrier and ask for a provider representative
for Podiatry. If they don't have one
specifically for Podiatry they should be able to get
you to someone who can help. Ask for the routine
foot care policies relating to 11055, 11056 and 11057.
They should be able to get you to the information
whether it be on-line or they can send you something.
Most likely on-line these days.
In the state of Washington these are covered services
and we bill the codes the following way: For one
callous on a patient who is "at risk" [DP
and PT pulses non-palpable- or DP or PT pulse
non-palpable and three other findings indicating
trophic changes (thin skin, decreased hair, thickened
nails, etc)we would bill 11055- Q8 with a Dx of
700 (callous) and 443.9 (unspecified peripheral
vascular disease). If two-four callouses you
would use the 11056 and five or greater 11057.
There are other ways of billing it in our state with
different secondary diagnosis depending on various
"at risk" conditions and the policy is quite
lengthy but that is the gist of it. I do not
know if the same policies hold true for Tennessee but
your local rep should be able to help you with that.
Scott Schroeder, DPM
Coding
Casting Materials
(Volume
108)
The
Question:
Hi Gayle,
I was wondering if you can offer any help on how we
can get Medicare to reimburse us for Code A4590,
special casting material. We have used it with
these diagnoses and have been denied - primary, 729.5,
secondary, 825.25, tertiary, 707.14. Any help
would be appreciated.
Thanks,
Mary Triolo
Alvarado Podiatry Center
The
Answers:
The
appropriate code for cast supplies for Medicare are as
follows:
Q4037- cast supplies-short leg cast-plaster-adult(11+
years)
Q4038-cast supplies-short leg cast-fiberglass-adult
Q4039-cast supplies-short leg-plaster-pediatric
Q4040-cast supplies-short leg
cast-fiberglass-pediatric
This includes all rolls of plaster or fiberglass and
padding per cast.
Scott Schroeder, DPM
A few years ago, Medicare (in their wisdom?)
developed a series of 52 cast supply codes, to replace
the 2 that had been used (including A4590). For
Medicare, each of these Q codes was specific for a
type of cast and age of the patient. Scott is
quite correct
I think Medicare thought everyone else would think
this was a great idea.... but no one else has
followed. A recent Federal Register would seem
to imply that Medicare will be moving away from their
stance (and going back to A4590, etc.? I doubt
it).
Rick Horsman, DPM
Olympia, WA
Coding
for Complications versus Staged Procedures
(Volume
108)
The
Question:
If we do
a partial debridement of a wound in the office and
code a 11040 and then send out for a wound culture,
isn't there something else we are supposed to be
billing for other then the 11040 and the 99213-25?
Maybe specimen handling?
We are simply sending out the culture to a laboratory
and awaiting results, but I thought perhaps we were
supposed to be able to charge for the specimen
handling here?
The other question I have is that if this is during
his global post-operative period, I can still bill
that, but I need the modifier 79 right, or is it
considered related because of the diagnosis 998.32
wound dehiscence?
Really curious,
Kelly
South Portland, ME
The
Answers:
There are several
components to the question, but the very first
important parameter is whether this is a Medicare
patient.
If so, any management of complications that does not
require a return to the OR is included in the global
allowance. So, evaluation and management of a
wound dehiscence, culture, debridement, antibiotics,
etc is all included in the global allowance-- for a
Medicare patient. If these services are
performed in the hospital OR or OSC, they can be
billed with a modifier, reflecting a staged and
related procedure. Otherwise, they're free.
P.S.: Medically necessary and documented x-rays
are billable.
For a non-Medicare patient, you can bill for both the
E/M and debridement. You really should not bill
for the specimen handling (it pays about $3 anyway).
If the problem is wound dehiscence, you may have
problems billing for these services after a prior
surgery. A diagnosis of cellulitis may be more
favorably considered.
Not every payer will reimburse for these services, so
you might be wise to contact the payer in question,
advise them of the problems the patient is having, and
what you intend to do (and charge for....), and get
some guidance from them
What you DON'T want is to provide a surgical procedure
to a patient, have a wound complication (which may or
may not be considered "the doctor's fault"),
and then hammer the patient with charges for
non-covered post op services.
Rick Horsman, DPM
A follow up on this
question-
If this is a diabetic or other type wound that
required debridement in the O.R. (I&D, or
debridement) and the doctor knew at that time that
this wound would likely require further debridement or
wound closure then this can be documented at the time
of surgery and further debridement codes and wound
closure codes should be covered with -58
modifiers (staged procedure during post-operative
period). This holds true even if all the
procedure codes have global periods. If the
physician performs a debridement in the operating room
of a wound into subcutaneous tissue (11042) which has
no global period and the patient is treated as an
in-patient or out-patient, these visits should be
charged for. If the procedure was an I&D
(10060-10061) or a 11043/11044 then a 10 day global
applies and an office visit or hospital visit would
not be able to be billed. However, if further
debridement was performed at bedside or in the office
then the appropriate debridement code (11040-11044)
with a -58 modifier should apply and be paid.
Please make sure your physician documents at the time
of original debridement or I&D that further would
care will most likely be needed.
Scott Schroeder, DPM
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