From: Michael G. Warshaw, DPM, CPC
In order to appropriately address the posted scenario, it is important to access the 2024 CPT Manual. Under Surgery Guidelines, you need to access the “Foreign Body/Implant Definition.” Foreign Body/Implant Definition:
• “An object intentionally placed by a physician or other qualified health care professional for any purpose (e.g. diagnostic or therapeutic) is considered an implant. An object that is unintentionally placed (e.g. trauma or ingestion) is considered a foreign body. If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes, unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.”
If Implant Needs to be Removed (i.e. Internal Fixation):
• 20680 Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)
If Foreign Body is Removed:
• 28190 Removal of foreign body, foot; subcutaneous
• 28192 Removal of foreign body, foot; deep
• 28193 Removal of foreign body, foot; complicated
Based upon the location and position of the broken K-wire described within the post, the most appropriate CPT code to bill is CPT code 28190 appended by the T2 or the T7 Modifier depending upon whether it was the left 3rd toe, or the right 3rd toe that was involved.
Michael G. Warshaw, DPM, CPC, Mount Dora, FL
From: Steven Berkey, DPM
According to my understanding of the guidelines, a K-wire that's broken and not performing the function for which it was intended now becomes a foreign body. The appropriate way to bill would be removal of a foreign body (deep) with a -78 modifier.
Steven Berkey, DPM, Plano, TX
Query: Noridian CMS Audit for CPT 11730
I received a request for office notes for 4 Medicare patients I billed CPT code 11730 last year. My notes are handwritten and not in the great detail CMS guidelines suggest. My notes include chief complaint, findings, and treatment. No detailed operative note was included. I used a local anesthetic and a nail border was excised. I will provide typewritten transcribed notes with NO alteration or embellishment of my written notes. What are the consequences of not passing scrutiny of Noridian? Advice?
Name Withheld
Query: Billing Patient for Next Day Visit
I saw a new patient yesterday. He showed up again today and was seen as he had additional questions. I spent about another 10 minutes or so with him which threw off the schedule some. Is it possible to bill his insurance for a follow-up office EP visit one day after the initial NP office visit?
Tom Silver, DPM, Minneapolis, MN
Query: Billing a Medicare ACO Patient
A patient has traditional Medicare as well as an ACO as primary coverage. I am not part of the ACO. Am I supposed to bill the ACO or bill traditional Medicare?
PM News Subscriber
Query: eChange Electronic Claims Hack
Has anyone changed their claims clearinghouse to start submitting and receiving claims payment? I am still awaiting return to normalcy! Any good recommendation or stay patient?
John Moglia, DPM, Berkeley Hts, NJ
Query: Documentation Requirements for L4396
L4396 (Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise) includes the need for "customization" within its description.
Outside of adjusting the straps and making sure that the device fits properly, what else should be documented to satisfy Medicare requirements? This DME device rarely needs to be bent, molded, or assembled for the treatment of plantar fasciitis.
PM News Subscriber
