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.

Easy bruising with no identifiable cause? Report 782.7

If you are wondering what the ICD-9 code for easy bruising is, read on and find out for yourself.

What's easy bruising?

Easy bruising is a symptom of another condition rather than a standalone diagnosis. As such, the ICD-9 code depends on whether or not the family physician identified a cause. If you identify the cause, then code for the specific disease. But again if no cause is pinpointed, then report for the symptoms.

How to report easy bruising?

For easy bruising with no identifiable cause, report 782.7 (Spontaneous ecchymoses). An individual may be ailing from other diseases that predispose him to develop bruises even with minimal trauma (say for instance a light rap on the hands), which normally will not happen to normal people, thus resulting in "easy bruising." Diseases that could result in this include platelet or coagulation disorders (thrombocytopenias), bone marrow disorders, hemophilias, liver diseases, and Marfan's syndrome. Aging and medications (for instance aspirin, prednisone, and other nonsteroidal anti-inflammatory drugs) can also lead to easy bruising. For patients suffering from these conditions, bruises seem to appear spontaneously without any identifiable reason.

What is ecchymosis, purpura and petechiae?

An ecchymosis is a bruise larger than 1 cm. A bruise less than 1cm but not less than 3 mm is said to be a purpura. A bruise less than 3 mm is a petechiae. Code 782.7 applies also to petechia but not purpura, which has various other codes (287.0-287.9) depending on the etiology.

Bruises from trauma can take place owing to a variety of reasons, including falls, accidents and post-surgeries. Normally, report codes 920-924 for bruises secondary to trauma. Say for instance a soccer player who was seen by a family pactice coding for bruises in the heel, report 924.20. Remember that as per ICD-9, these codes exclude contusions that are incidental to specific categories of injuries, like crushing injury, dislocation, fracture, internal injury, intracranial injury, nerve injury, and open wound.

Learn Constitutes an Acceptable Signature

If you want to get paid correctly, you'll need to ensure physicians and non-physician practitioners (NPP) sign your paper lab requisitions. But what exactly what does that require?

The agency provides specific guidance on what constitutes an acceptable "signature" for documents subject to review for Medicare payment or by an audit contractor. See to it that your documents match by complying with one of the following options:

You need to ensure it's legible

The simplest signature and most difficult to ensure is a legible full-name signature or a legible signature using first initial and last name.

Unluckily, you will not find many physicians or non-physician practitioners who have a legible signature and you most certainly won't want to stake your payment on it. This is when you need to turn to option 2.

You should accept printed name with scribble

If you cannot count on ordering physicians and non physician practitioner to legibly sign requisitions, you do have an alternative choice. Other personnel like a circulating nurse can print the full name of the ordering physician/NPP on the requisition. After this the physician/NPP can initial next to or above the full printed name. In this instance, the initials don't have to be legible to count as a legitimate signature.

Alternatively, if you submit a signature log or attestation statement that identifies the signer of an illegible signature, you can meet the signature requirement this way.

Don't wait. Just do it. There's no doubt that getting referring physicians and non physician practitioners to comply with Medicare's new policy for acceptable paper requisition signatures will be tough, however compliance is important if pathologists and laboratories are to continue to be paid for their work.