Cpt 2011 Changes Affecting Your Podiatry Coding

This year, CPT introduced over 200 new codes to help you code more accurately. The changes have affected several practices and your podiatry practice is no exception. For this practice, the big change focuses on two new codes to report diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity.

Also, you will use various G codes while reporting diabetic foot ulcer treatment involving tissue cultured skin substitutes to the lower extremity for a Medicare beneficiary this year.

This time CPT introduces Code G0440 and G0441 which will put an end to the confusion providers put forth the different global periods for two tissue cultured skin substitute codes.

This year, for your ultrasound coding, you will not use 76880 as this code has made way to two new codes - 76881 and 76882.

A complete procedure (76881) includes real time scans of a specific joint that includes examination of the muscles, tendons, joint, other soft-tissue structures, and any identifiable abnormality. A limited study (76882) involves examining the extremity where a specific anatomic structure such as a tendon or muscle is assessed.

Bear in mind that when the podiatrist carries out spectral and color Doppler evaluation of the extremities, you should use the proper code with 76881 or 76882. In the meantime, CPT has also revised and revalued codes for noninvasive physiologic studies of the upper or lower extremity arteries: 93922, 93923, 93923, 93924.

And if you were confused about choosing between a debridement code and an active wound code, this year’s CPT saves the day by revising debridement code guidelines.

Faqs to Bring You the Rightful Reimbursements for Your Hammertoe Coding

Question: My payer does not recognize modifiers. What can I use in its place?

You might require modifiers to help differentiate work on different areas of the feet or toes. But then it is not normal to have a carrier prohibit the use of toe modifiers, which run sequentially from TA (Left foot, great toe) and T1 (Left foot, second digit) to T9 (Right foot, fifth digit). To differentiate between toes operated on try using modifier 59. Also, you can go for modifier 59 in combination with the toe modifiers: Say for instance 28899-59-T3.

Question: My patient broke his toe (a closed fracture) three days after I carried out a hammertoe correction on that toe (T7) and another toe on the same foot (T8). How should I report this?

As there's no treatment for a broken toe, you could bill the office visit 9921x-24 (Unrelated E&M service by the same doctor during a post-operative period) and cover the ICD-9 code for a fractured toe, 826.0 (Fracture of one or more phalanges of foot, closed).

Since I do not want to use the unlisted-procedure code, what other procedures are close enough to hammertoe to be billed as a hammertoe?

You should think about reporting hammertoe code 28285 for the correction of claw toe or mallet toe.

Question: So can I bill for removal of a K-wire?

The answer is no. you may not bill the removal of a K-wire separately. It's bundled into the procedure. Reporting 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) wouldn't be proper too. If the pin is outside the skin, you cannot bill for it. But then if it needs to be removed because it has been cut and buried beneath the skin, go for 20680 and add modifier 78 which tells the insurance company it was necessary to do a second procedure on the patient.

Is a tenotomy included in the hammertoe procedure?

Well, yes, the tenotomy is included and it should not be billed for separately. But then if you look closely, at the present National Correct Coding Initiative edits only 28234 is listed as bundled into the procedure, not 28232. The flexor tenotomy procedure may be billed differently if a separate incision is used.

Ingrown Toenail Removal Coding Confusions? 11750 Answers Them

In a particular case, a patient presents for a follow-up of an ingrown toe nail. The podiatrist finds that the patient now has two ingrown toenails – one on each foot. He removes both from each toe and also did a silver nitrate cauterization. How should I report this? Should I report 99212-25?

Well, the answer is yes. Besides coding 99212-25, you should bill 11750 (Excision of nail and nail matrix, partial or complete [example, ingrown or deformed nail], for permanent removal) appended by modifier 50 (Bilateral procedure).

Logic for evaluation & management: Since the diagnosis is new to one toe, you could justify 99212 (Office or other outpatient visit for the E/M of an established patient which requires at least two of these three key components: a problem focused history; a problem focused examination, and straightforward medical decision making; Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). The patient presents for follow-up of one ingrown toenail. However, the podiatrist has not examined the other (new) ingrown toenail earlier.

Adding modifier 25 (Significant, separately identifiable E&M service by the same physician on the same day of the procedure or other service) to 99212 indicates the podiatrist carries out a significant, separate service from the ingrown toenail removal.

Logic for incision: You should report each toenail removal: 11750 for the first complete removal and 11750 for the second removal. Using modifier 50 to the second removal tells the insurer that the podiatrist carries out the toe removal as bilateral procedure.

For more specialty-specific articles to help your podiatry coding, stay tuned to a medical coding resource like CodingInstitute.com .