Query: Orthotics Denial
A male patient was seen for bilateral plantar fasciitis. The decision was made to proceed with custom orthotics, and Bio-foam impression casting was done and documented. The patient was dispensed the devices about 3 weeks later, and the claim was submitted to Wellmark Blue Cross Blue Shield of Iowa using L3000 LT,GA and L3000 RT, GA. We received a pre-payment medical record request from Optum, and after review of the records submitted, the claim was denied with the reason: "Documentation does not support services billed" with additional Remarks: “Not supported. The submitted medical records do not contain sufficient details of custom fabrication of the orthotic to support the billed charges. A custom fabricated item is one that is individually made for a specific patient. Of note, classification of custom fabricated requires a device which is fabricated based on clinically derived and rectified castings, tracings, measurements, and/or other images of the body part."
We submitted additional records, including the progress note from the visit at which the impressions were done, as well as the orthotic lab invoice with the patient's name, but it was again denied with the same reasoning.
Any suggestions on how to satisfy this documentation requirement when the fabrication and customization is done at an outside lab? It appears in this case that our billing service was able to appeal and get the claim paid, but it was a total of 9 months from the date of service.
Michael Orosz, DPM Cedar Rapids, IA
Query: Coding Punctate Keratosis
I have recently seen a patient with multiple, too numerous to count, punctate keratosis of the soles of her feet and palms of her hands. The condition runs in her family. I have recommended that she apply 40% urea cream to the soles of her feet at bedtime with occlusion and to use a callus file weekly.
I will see her for follow-up re-evaluation on a PRN basis for palliative care. She is 79 years old in good health with no at-risk qualification. What is the appropriate ICD-10 and CPT coding?
PM News Subscriber
Query: Local Sympathectomy of Posterior Tibial Nerve
Are nerve blocks in a foot with PVD and ulcers covered the day of debridement, if used as a local sympathectomy of the posterior tibial nerve?
PM News Subscriber
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Query: Source for Reputable Coding and Billing Company
I’m a podiatrist practicing in Arlington, Virginia. I’m looking for a reputable company to do my billing and coding.
Damaneon Smith, DPM
Query: Coding for Haglund’s Deformity
I am an orthopedic coder and we have been discussing if the CPT code we have been using to remove a Haglund's deformity is correct. I was taught that for removal of a Haglund's deformity, we are to use the CPT code 28118. If though the deformity is large or extra bone has to be taken out, we use the CPT code 28120. Now I am being asked, where in the CPT book does this explain this situation. Would any of you have information to help me in this matter?
Pamela Abshire, CPC
