|
|
|
|
|
Search
11/21/2024
QUERIES (CODING & BILLING)
Query: Billing for Flatfoot
I recently received a denial from a patient with Medicare for CPT code of 99202 with the following ICD codes M21.41, M21.42, M79.671, and M79.672. It was listed as a denial due to flatfoot as exclusion with Medicare. I understand the Medicare exclusion of flatfoot, but my question is how would you bill/what ICD codes for a patient who needs flatfoot surgery and only has Medicare?
My question extends to the visits leading up to the actual surgery as well. The denial is for what I would normally use for those visits leading up to surgery.
Kyle Gleeson, DPM, Miami Beach, FL
Other messages in this thread:
12/21/2024
QUERIES (CODING & BILLING)
Query: Coding Tendon Lengthening with Subtalar Arthrodesis
Can both CPT 27686 and CPT 28725 be coded together when the tendon work was for tightened tendons and needed for better talar mobilization. The talar head was not reducing and there was still severe tightness at the peroneal tendons. Both the peroneus brevis and the peroneus longus were Z-lengthenings for later repair (at the conclusion of the case) inferior to the fibula. Next, the calcaneocuboid joint was opened and mobilized placing a pin distractor across this joint to aid in this mobilization.
There was still significant tightness and very limited ability to reduce the talar head, and the patient had a severe tightness to his Achilles tendon left in about 30 degrees of equinus when the reduction was nearly completed. The decision at this point was made for an Achilles tendon lengthening and a triple Hoke-style lengthening was performed with two of the cuts being towards the lateral side of the tendon to aid in correction of the valgus.
PM News Subscriber
12/02/2024
QUERIES (CODING & BILLING)
Query: What is Needed in an Encounter Note
With the advancing capacity of AI note-taking technology, I have come to question what is needed in an encounter note. The simple answer is that a note should include relevant medical information. But I am not interested in what it should include because that can waste time. My question is what must be in a medical note to pass an insurance audit. The term "relevant" is very subjective. For instance, a patient's family history, social history, dermatological findings, and vital signs are irrelevant to how I treat their plantar fasciitis.
Carl Speer, DPM, Pensacola, FL
10/30/2024
QUERIES (CODING & BILLING)
Query: Continuing Skin Substitute Therapy
I was treating a Medicare Advantage patient's venous wound with skin substitutes. During this time period, she broke her wrist and was admitted to a rehab facility. Now that she is being discharged, she would like to resume treatment, as there was much improvement. The concern I have is that she has since changed to regular Medicare AND it is outside of the 12-week treatment period. Is there any way to continue treating her? Does the change of insurance matter?
PM News Subscriber (FL)
10/29/2024
QUERIES (CODING & BILLING)
Query: Source to Change Solo to Group NPI
Can anyone recommend a reliable service that they have worked with to help with changing the NPI number billed under with all the insurance carriers contracted with a podiatry practice? I am not talking about initial credentialing, just changing from a solo practitioner NPI to a group NPI?
Name Withheld
10/12/2024
QUERIES (CODING & BILLING)
Query: Coding for Lapiplasty, Akin, and Silver Bunionectomies
How do you code for Lapiplasty, Akin, and Silver bunionectomies. Are these all considered double osteotomies?
Ali Davis, DPM, Overland Park, KS
08/13/2024
QUERIES (CODING & BILLING) - PART 1A
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
08/13/2024
QUERIES (CODING & BILLING) - PART 1B
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
08/12/2024
QUERIES (CODING & BILLING)
Query: Coding for Removing Broken K-Wire
I would like to know how to bill this scenario appropriately. I performed hammertoe surgery on the 2nd and 3rd digits and stabilized with an embedded K-wire. On the 3rd toe, within the post-operative period, the K wire broke through the middle phalanx and became prominent underneath the skin. It was causing significant pain, so in the office setting I numbed the toe, incised through the skin and subcutaneous tissue, and extracted the K-wire without incident. Sutures were applied to close the wound thereafter. Post-operative x-rays were taken to confirm complete removal of the K-wire and to re-evaluate alignment of the 3rd toe. Advice would be appreciated.
PM News Subscriber
07/17/2024
QUERIES (CODING & BILLING)
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
07/11/2024
QUERIES (CODING & BILLING)
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
04/22/2024
QUERIES (CODING & BILLING)
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
04/17/2024
QUERIES (CODING & BILLING)
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
04/04/2024
QUERIES (CODING & BILLING)
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
|
| |
|
|
|
