The Free Online Podiatry Coding Class - Student Doctor Network

[Adam Smasher]

28292 Left reverse silver

bumpectomy is a 28110

28039 Soft tissue mass excision foot

specify size, it might be a 28043 if it's <1.5cm

64702 Nerve decompression foot

lolwut

14040 Skin plasty

what size do you wear your orange jumpsuit? it takes more than an S-incision to count as a flap rearrangement

Reimbursement: $500? 79 modifier for the silver, hopefully that lets you get paid for doing a 4th procedure

I'm also confused by the 79 mod, is this operation taking place during a global for something else? 79 is procedure performed during global unrelated to the index procedure (example: trim toenails of R foot the week after L foot TMA)

I attended the ACFAS surgical billing conference my first or second year as an attending, it paid for itself

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[HardRoadPaved]

ICD10: M21.622 Left bunionette

👍

M79.9 Soft tissue mass

terrible code to use for many payers. This is why you code it after biopsy returns. However if you need prior auth beforehand use a better non-specific code. D48 series gives you at least mass of uncertain behavior

CPT: 28292 Left reverse silver

No. No. No. No. No. There is literally bumpectomy code for tailors bunions 28110

28039 Soft tissue mass excision foot

Need the size, benign, depth to determine 280xx

64702 Nerve decompression foot

No.

14040 Skin plasty

Fraud.

Reimbursement: $500? 79 modifier for the silver, hopefully that lets you get paid for doing a 4th procedure

Reimbursement: removed from insurance panel for this billing.

 

[ExperiencedDPM]

28110 for the bunionette

14040 for what? This code is NOT for excising an ellipse of skin or a lazy S incision. It’s a soft tissue transfer or rearrangement.

64702 is part of your surgical approach, as per NCCI.

And by the way, if you are excising a lesion and it required a legitimate 14040, the lesion excision is included in the 14040

Keep up this blatant fraud and you’ll be in jail soon.

If you truly bill this crap for a bunionette, you’re a low as they get. And you ruin it foe everyone else. Few things light me up as much as fraudulent billing.

 

[heybrother]

What's the point of all those fraudulent codes if all you get is $500.

 

[Feli]

28110 -LT for Tailor bunion exostectomy bump n run... no debating that one. The day I ever do a surgery with that as my primary procedure, I'm out the game. Wow.

28043 -59 -LT or similar on the "mass between metatarsal midshaft 2 +3" mass (correct CPT depends if subcut or subfascial and size greatest dimension).

...the 14040 is only for bilobe and rotation flaps and such. Also no on the nerve surgery code for excision mass. I think you need to submit APMA podiatry fellowship orthoplastic certificate to the payer and have prior auth to bill those. Prior auth will typically take proof of failing ABFAS multiple times, yet passing all CAQs available on date of sugrery. The 14040 are most typically done with other 14040s, a nerve stimulator or two, a bunch of streuvixxx, and an ex fix on 330 pound Charcot patients who will get a BKA a few months later... by associates getting 30 or 35% of collections... or 'academic' DPMs. 🙂

In all seriousness, this stuff is not uncommon. Some residencies teach this. There are tons of DPMs who bill V-to-Y on routine hammertoes. I had one DPM guy who I did some revisions after (had to request orig op reports) who was doing 64727 on nearly all of their bunions, hammertoes, whatever.... multiple if there were multiple incisions. I have no idea if they were getting paid... but I do know the facility did not have an OR microscope. 🙁

 

[air bud]

28110 -LT for Tailor bunion exostectomy bump n run... no debating that one. The day I ever do a surgery with that as my primary procedure, I'm out the game. Wow.

28043 -59 -LT or similar on the "mass between metatarsal midshaft 2 +3" mass (correct CPT depends if subcut or subfascial and size greatest dimension).

...the 14040 is only for bilobe and rotation flaps and such. Also no on the nerve surgery code for excision mass. I think you need to submit APMA podiatry fellowship orthoplastic certificate to the payer and have prior auth to bill those. Prior auth will typically take proof of failing ABFAS multiple times, yet passing all CAQs available on date of sugrery. The 14040 are most typically done with other 14040s, a nerve stimulator or two, a bunch of streuvixxx, and an ex fix on 330 pound Charcot patients who will get a BKA a few months later... by associates getting 30 or 35% of collections... or 'academic' DPMs. 🙂

In all seriousness, this stuff is not uncommon. Some residencies teach this. There are tons of DPMs who bill V-to-Y on routine hammertoes. I had one DPM guy who I did some revisions after (had to request orig op reports) who was doing 64727 on nearly all of their bunions, hammertoes, whatever.... multiple if there were multiple incisions. I have no idea if they were getting paid... but I do know the facility did not have an OR microscope. 🙁

Everything is a 14040 if think hard enough

 

[PODIATRYCRAZE]

Modifier Guide

22 Unexpected complication occurs during surgery requiring an additional procedure to be performed. (Tumor, foreign body, parasites)

24 Evaluation performed during global period of an unrelated surgery

25 Evaluation and management code separate from a procedure code used on the same day. (Flat foot E&M with plantar fasciitis injection)

50 Bilateral procedure. (Bilateral 2nd hammertoe)

58 Expected secondary procedure. (Skin grafts, delayed closures, external fixator removal)

59 Procedure separate from a procedure performed on the same day. (Bunion + hammertoe)

62 2nd assist surgeon. Both surgeon's get reimbursed 62% of the surgery for a total of 124% reimbursement.

78 Unexpected complication occurs after the surgery requiring an additional procedure to be performed. (Incision + drainage, nonunion)

79 Procedure performed unrelated to initial surgery within global period (Left foot bunion one month then patient trips and breaks right ankle, add this modifier to the right ankle ORIF)


RT Right lower extremity
LT Left lower extremity

TA-Left hallux
T1- Left 2
T2- Left 3
T3- Left 4
T4- Left 5
T5- Right hallux
T6- Right 2
T7- Right 3
T8- Right 4
T9- Right 5

 

[Adam Smasher]

Someone's going to correct the above, but I'll state for now parasites are always expected on the pus bus

 

[ExperiencedDPM]

Modifier Guide

22 Unexpected complication occurs during surgery requiring an additional procedure to be performed. (Tumor, foreign body, parasites)

25 Evaluation and management code separate from a procedure code used on the same day. (Flat foot E&M with plantar fasciitis injection)

50 Bilateral procedure. (Bilateral 2nd hammertoe)

58 Expected secondary procedure. (Skin grafts, delayed closures, external fixator removal)

59 Procedure separate from a procedure performed on the same day. (Bunion + hammertoe)

62 2nd assist surgeon. Both surgeon's get reimbursed 62% of the surgery for a total of 124% reimbursement.

78 Unexpected complication occurs after the surgery requiring an additional procedure to be performed. (Incision + drainage, nonunion)

79 Unrelated procedure performed to initial surgery within global period (Left foot bunion one month then patient trips and breaks right ankle, add this modifier to the right ankle ORIF)


RT Right lower extremity
LT Left lower extremity

TA-Left hallux
T1- Left 2
T2- Left 3
T3- Left 4
T4- Left 5
T5- Right hallux
T6- Right 2
T7- Right 3
T8- Right 4
T9- Right 5

22 modifier is not for an additional procedure. It’s for a complication of the planned procedure.

Per Encoder Pro: When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service.

 

[heybrother]

Happy New Year expDPM!

 

[PMG03470]

Can anyone help with coding the following scenarios:

1) Revision of Lapidus non-union, I’m literally just going to resect more bone and harvest BM from the calc with Stryker’s kit to use at the fusion site.


2) Revision of hammertoe arthrodesis. A slight recurrence occurred after the K-wire was pulled, patient is not happy so I am going to revise with smart toe.

3) tailors bunionectomy with osteotomy.

Thanks!

 

[HardRoadPaved]

1) 28320 + 20900/2 (depending on graft size)

2) 28285

3) 28308

 

[heybrother]

Can anyone help with coding the following scenarios:

1) Revision of Lapidus non-union, I’m literally just going to resect more bone and harvest BM from the calc with Stryker’s kit to use at the fusion site.


2) Revision of hammertoe arthrodesis. A slight recurrence occurred after the K-wire was pulled, patient is not happy so I am going to revise with smart toe.

3) tailors bunionectomy with osteotomy.

Thanks!

My big thing on revisions is you have to be careful with "one time codes" on BCBS if you did the 1st case.

"This service is paid only once in a patient's lifetime."

-My partner at one point billed a 5th metatarsal osteotomy as a 5th metatarsal head resection (sloppy). So he used 28113 for the osteotomy. Impressively the patient non-unioned it. When he billed 28113 for the revision where he actually removed the head and the non-union BCBS denied it because - you can only resect the head once.

-Similarly, if you non-union a 1st MPJ fusion and revise it - BCBS in my experience will deny a 28750 the second time because it already happened. You need to use one of those revision of non-union codes as noted above.

-I have revised other people's non-unions though ie. botched lapidus and I had no issue using 28740. Interestingly, every botched lapidus I have been given was both wide open ie. non-reduced and a non-union.

 

[PMG03470]

My big thing on revisions is you have to be careful with "one time codes" on BCBS if you did the 1st case.

"This service is paid only once in a patient's lifetime."

-My partner at one point billed a 5th metatarsal osteotomy as a 5th metatarsal head resection (sloppy). So he used 28113 for the osteotomy. Impressively the patient non-unioned it. When he billed 28113 for the revision where he actually removed the head and the non-union BCBS denied it because - you can only resect the head once.

-Similarly, if you non-union a 1st MPJ fusion and revise it - BCBS in my experience will deny a 28750 the second time because it already happened. You need to use one of those revision of non-union codes as noted above.

-I have revised other people's non-unions though ie. botched lapidus and I had no issue using 28740. Interestingly, every botched lapidus I have been given was both wide open ie. non-reduced and a non-union.

I don’t think the non-union is really my fault, my one screw may be a bit short and not getting enough compression. However she was found 2 months post op to have a Vit D of 13. Since this case I check Vit D on all fusions out of fear. Feel free to critique the XRs, I use Styker lapifuse now though and have had no non-unions. The original case was over a year ago.

 

[deleted285117]

I don’t think the non-union is really my fault, my one screw may be a bit short and not getting enough compression. However she was found 2 months post op to have a Vit D of 13. Since this case I check Vit D on all fusions out of fear. Feel free to critique the XRs, I use Styker lapifuse now though and have had no non-unions. The original case was over a year ago. View attachment 380211
View attachment 380212

Nice. I’ve been moving more toward nitinol staples - love those things!!!

I’ll be practicing in OH soon… pretty much gonna assume everyone vit D deficient there 🥴

 

[heybrother]

I don’t think the non-union is really my fault, my one screw may be a bit short and not getting enough compression. However she was found 2 months post op to have a Vit D of 13. Since this case I check Vit D on all fusions out of fear. Feel free to critique the XRs, I use Styker lapifuse now though and have had no non-unions. The original case was over a year ago.

I'm not here to beat your work up or assign blame. I probably should have just left out that whole remark about botched lapidus.

How to approach and revise failure of surgery is one of those things that is fascinating to me. Is trust lost, is blame assigned, etc. One of my attendings used to almost run from the room to get to a computer and write non-compliant and explain how the patient had failed him. The other fascinating thing is - how quickly will the doctor acknowledge that the surgery has failed. How long will they push it out for etc.

 

[HardRoadPaved]

Hmm these x-rays look like something out of an ABFAS exam.

Did you get a CT of the joint?

Most of the time I wouldnt blame hardware but that nice oblong hole that you didnt use is meant to compress the joint. I wouldnt put much faith in a cannulated screw to do the job. Go solid next time and use the plates as intended.

 

[PMG03470]

Hmm these x-rays look like something out of an ABFAS exam.

Did you get a CT of the joint?

Most of the time I wouldnt blame hardware but that nice oblong hole that you didnt use is meant to compress the joint. I wouldnt put much faith in a cannulated screw to do the job. Go solid next time and use the plates as intended.

Yeah the CT is how I diagnosed the non-union. But yeah I agree, this was actually my first Lapidus out of residency. I used the Lapifuse system now and results have been good.

 

[Feli]

Lapidus non-union happens all the time. It happens to anyone. It's in the literature... roughly 1/10 or 1/20ish.
If it's a regular thing, that's a problem with pt selection or technique or whatever.

The younger folk seem enamored by the 'systems' and kit' options. They are no subsitute for technique.
The "system" doesn't matter... it's technique over technology. Resect the joint and position it well. It can work with screws or plates or even big pins... or other dumb stuff (ex-fix, mini nail, etc).

One thing to realize is that cannulated screws are SUBSTANTIALLY weaker at the sizes for forefoot surgery (below about 4.5mm).
A lot of people don't seem to get that. Solid screws are much better for bunions, mets, etc. Titanium is also weaker than steel (size for size).
We have to use logic instead of rep sales tactics.

...The code for a revision fusion (or any procedure) is same as the original, but I agree with the possible one per lifetime (so 28297 or 28740 ... whichever you know was not used on the original). If you don't know, use 28740.

Bone graft is 20900 (curette/small bits) or 20902 (legit cube from superior calc... not what you'd need for a Lapidus unless it was real short first ray).

 

[air bud]

Check vitamin D on any fusion more than a hammertoe. 50k units a week for 6 weeks. Lapidus looks like great reduction forget what you learned about resecting medial eminence leave it alone.

Edit - seriously. Once you start checking vitamin D you will realize how common it is. I hand out 50k units a week for 6 weeks like candy. Fat, 50 and white (no facture seen on x-ray) - they ain't got no D. Under 50 and a kid within last year or 2? No D. Source: trust me bro.

 

[PODIATRYCRAZE]

HPI: 93M Established patient of yours who had heel eschar which was improving has now had a severe decline in health. Typically he would come to your office with his son every 2 weeks over the past 2 months for a check on his wound. Now he is bed bound and hardly responsive. No pain response. Eschar is stable today, decreased in size, even if he was in better overall health decision is to continue conservative wound care.

Treatment: Go to his home, inspect the eschar. It is stable, ensure that he is wearing an offloading cushion boot.

 

[PODIATRYCRAZE]

ICD: L97.51 Chronic ulcer of right foot

CPT: 99348 Level 3 House call

Reimbursement: $100?

 

[Adam Smasher]

I admire the intent of this thread, so I hate to troll you, but sometimes it seems like you're just making up numbers

 

[deleted285117]

I admire the intent of this thread, so I hate to troll you, but sometimes it seems like you're just making up numbers

 

[heybrother]

A patient presents for their first visit. Perhaps they have equinus or "instability" or whatever. You discuss shoes, stretching, orthotics, night splint, cotton padding, taping, shockwave - whatever form of regional torture you prefer. X-rays are performed. Meloxicam is prescribed. An injection is performed of the plantar fascia or the subtalar joint or whatever. It is all beautifully documented in a PROBLEM #1, PROBLEM #2 format to make Jeff L happy. Perhaps you even comment on their need for terbinafine or urea because you like to make your visits longer. Whatever.

It is now the next visit.

Visit #2. The shot reduced their discomfort by 30%. You dutifully reexamine their sensitive foot to confirm your exam findings. They would like another injection. They specifically ask for a meloxicam refill. A cursory discussion is performed of their prescriptions and lack of complications. Forget the 3 second discussion you performed of their continued need for stretching and orthotics. If a 20550 and a meloxicam refill are performed at the second visit - does the medication refill ("prescription drug management") always justify the 25 modifier E&M visit with the injection.

-In this scenario you are not named Dyk so its technically feasible that you could be reimbursed for both codes as opposed to just the injection...
-However, you are a lazy coder and intend to place both the 20550 and 99213 on the same diagnosis. Is that relevant?

Modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or OtherQualified Health Care Professional on the Same Day of the Procedure or Other Service

 

[PODIATRYCRAZE]

I admire the intent of this thread, so I hate to troll you, but sometimes it seems like you're just making up numbers

I am making up numbers, at least for the reimbursement part. From what I can see from the billing sheet it might actually be as high as $150-$200. But I am not sure what percent of that they will actually pay out

 

[Adam Smasher]

I am making up numbers, at least for the reimbursement part. From what I can see from the billing sheet it might actually be as high as $150-$200. But I am not sure what percent of that they will actually pay out

I'm talking about the coding. A decubitous heel ulcer is L89.6XY, where X =1 for right, 2 for left, and Y reflects the staging. If there's an eschar over it, it's an unstageable heel ulcer, and Y=0. If your patient has a left foot unstageable heel ulcer, it's L89.620

As for the E/M, I don't do housecalls often, but I struggle to see how it's a level 3.

Someone else can comment on the medical rationale for reappointing a heel ulcer every 2 weeks and not doing anything for it...

 

[heybrother]

I'm talking about the coding. A decubitous heel ulcer is L89.6XY, where X =1 for right, 2 for left, and Y reflects the staging. If there's an eschar over it, it's an unstageable heel ulcer, and Y=0. If your patient has a left foot unstageable heel ulcer, it's L89.620

As for the E/M, I don't do housecalls often, but I struggle to see how it's a level 3.

Someone else can comment on the medical rationale for reappointing a heel ulcer every 2 weeks and not doing anything for it...

The code he listed is no longer in force in the Medicare fee schedule.

The 30 minute home health visit code pays $70 where I am. In one locality in the entire United States it pays $100. If a MA / Medicaid etc plan is on the table it will be less than that. For example, the relevant code back in the day on Humana would have paid me sub-$50.

I don't believe there's anywhere that it pays $150-200 under any circumstance...

 

[dtrack22]

As for the E/M, I don't do housecalls often, but I struggle to see how it's a level 3.

“Time”

 

[PODIATRYCRAZE]

HPI: Your partner went on vacation for 1 week, his patient operated on a hammertoe on Friday and scheduled 2 week follow up. Tuesday morning the patient calls saying she feels something is wrong, denies any trauma. 43F no past medical history. Once you see her, the toe is mildly swollen, skin looks fine, pin looks fine.

Treatment: Release the bandage, instant pain relief. Rewrapped. Follow up with original appointment

 

[PODIATRYCRAZE]

ICD: M20.41 Right foot hammertoe

CPT: 99024 Postoperative visit

Reimbursement: $0 because it is a postoperative visit still within the global period even though it was not your postop. If the patient came from another office not associated with you, you could still bill a 9920X office visit.

 

[Hybrocure]

ICD: M20.41 Right foot hammertoe

CPT: 99024 Postoperative visit

Reimbursement: $0 because it is a postoperative visit still within the global period even though it was not your postop. If the patient came from another office not associated with you, you could still bill a 9920X office visit.

Good thing the surgeon sent them to me for nails 🦞

 

[air bud]

Still thing we need to clarify lobster work. Nails callus orthotics vs pus bus. Both ugly nobody wants to do but big difference on multiple levels. Employment reimbursement time commitment etc.

 

[Hybrocure]

If an urgent care or ED bills a fracture code but they refer the patient to your office and you bill a fracture code do you get paid?

 

[Hybrocure]

Still thing we need to clarify lobster work. Nails callus orthotics vs pus bus. Both ugly nobody wants to do but big difference on multiple levels. Employment reimbursement time commitment etc.

Anything below a TMA is lobster

 

[HardRoadPaved]

If an urgent care or ED bills a fracture code but they refer the patient to your office and you bill a fracture code do you get paid?

Send out your claim first.

I haven't run into this issue with any payer

 

[PODIATRYCRAZE]

HPI: 55M ambulatory at baseline with posterior heel ulcer showing osteomyelitis on MRI.

Treatment: Partial calcanectomy with Achilles tendon reattachment

 

[PODIATRYCRAZE]

ICD: M86.817 Right calcaneus osteomyelitis

CPT: 27650 Achilles tendon repair
28118 Calcaneus infection resection

Reimbursement: $700? A couple things about this one. Not sure if this can be modified because the problems are kind of related. In real life I would probably test my luck out and modify for full reimbursement to test my luck. But let's play by the rules,

Secondly, the order which I put them seems backwards, but it is important 27650 can pay around $600 and 28118 about $500. Now remember that the second procedure gets half reimbursement (without modifiers) so $600 + $250 = $850 versus $500 + $300 = $800.

For the young readers wondering what about bone biopsy, or wound debridement codes? the 3rd procedure get 25%, so at this point you would be making pennies. Do not waste your time, but more importantly do not risk what is not allowed. For 28118 the wound debridement and bone biopsy codes are already assumed. You cannot unbundle that much.

 

[air bud]

ICD: M86.817 Right calcaneus osteomyelitis

CPT: 27650 Achilles tendon repair
28118 Calcaneus infection resection

Reimbursement: $700? A couple things about this one. Not sure if this can be modified because the problems are kind of related. In real life I would probably test my luck out and modify for full reimbursement to test my luck. But let's play by the rules,

Secondly, the order which I put them seems backwards, but it is important 27650 can pay around $600 and 28118 about $500. Now remember that the second procedure gets half reimbursement (without modifiers) so $600 + $250 = $850 versus $500 + $300 = $800.

For the young readers wondering what about bone biopsy, or wound debridement codes? the 3rd procedure get 25%, so at this point you would be making pennies. Do not waste your time, but more importantly do not risk what is not allowed. For 28118 the wound debridement and bone biopsy codes are already assumed. You cannot unbundle that much.

There has to be a lot more you're doing here, I assume you're putting on a wound vac which you can bill for. Why are you billing for reattaching the Achilles if you are resecting bone. You're going to stage this also. And in regards to 25% of whatever again Hospital employed RVs it doesn't work like that usually, usually you get 100% of each procedure. Again very different models Private Practice versus employed. Anybody with what you're describing is likely at least two surgeries as an inpatient

 

[heybrother]

1. This is a multi-stage procedure ultimately ending in BKA.
2. A funner question still - can you even bill an Achilles repair if the detachment was performed to access the calcaneus and address osteomyelitis. I think most people would try, but is this different than an osteotomy of the medial malleolus to address talar joint pathology.
3. Low procedural reimbursement isn't a reason not to bill a code. I only know of one insurance plan (Aetna) that reduces 3rd and later procedures to 25%. If I do a 1st ray + 4 hammertoes on an Aetna patient - do I not bill the later procedures because its not worth it?
4. See Chapter 1 and Chapter 4 of the CMS NCCIPM concerning charging the biopsy and debridement (no, you probably cannot).

 

[air bud]

1. This is a multi-stage procedure ultimately ending in BKA.
2. A funner question still - can you even bill an Achilles repair if the detachment was performed to access the calcaneus and address osteomyelitis. I think most people would try, but is this different than an osteotomy of the medial malleolus to address talar joint pathology.
3. Low procedural reimbursement isn't a reason not to bill a code. I only know of one insurance plan (Aetna) that reduces 3rd and later procedures to 25%. If I do a 1st ray + 4 hammertoes on an Aetna patient - do I not bill the later procedures because its not worth it?
4. See Chapter 1 and Chapter 4 of the CMS NCCIPM concerning charging the biopsy and debridement (no, you probably cannot).

If vascular ok this is not a bka with some compliance. Debride, NWB IV antibiotics. Skin closed then either brace vs IM nail. If hardware then make no infection. Legit biopsy etc. multiple procedures. Lots of care and costs. But it's not like BKA is a smooth walk in the park over and done with. Save the leg. You lose feet to infection, legs to vascular.
Agree on everything else.

 

[ExperiencedDPM]

1. This is a multi-stage procedure ultimately ending in BKA.
2. A funner question still - can you even bill an Achilles repair if the detachment was performed to access the calcaneus and address osteomyelitis. I think most people would try, but is this different than an osteotomy of the medial malleolus to address talar joint pathology.
3. Low procedural reimbursement isn't a reason not to bill a code. I only know of one insurance plan (Aetna) that reduces 3rd and later procedures to 25%. If I do a 1st ray + 4 hammertoes on an Aetna patient - do I not bill the later procedures because its not worth it?
4. See Chapter 1 and Chapter 4 of the CMS NCCIPM concerning charging the biopsy and debridement (no, you probably cannot).

You are correct. You can not get paid (legally) for reattaching a tendon YOU detached. That’s not a repair, that’s part of your closure. This is addressed in NCCI policy regarding approach and protect. If your surgical approach includes detaching the tendon, it is included.

If there’s diseased tissue in your surgical approach such as scar tissue, small cyst, etc., it’s also included.

 

[heybrother]

You are correct. You can not get paid (legally) for reattaching a tendon YOU detached. That’s not a repair, that’s part of your closure. This is addressed in NCCI policy regarding approach and protect. If your surgical approach includes detaching the tendon, it is included.

If there’s diseased tissue in your surgical approach such as scar tissue, small cyst, etc., it’s also included.

For future readers, this appears to come from CMS NCCI Chapter 1, Section B

https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-1.pdf

"Many NCCI PTP edits are based upon the standards of medical/surgical practice. Services that are integral to another service are component parts of the more comprehensive service."

"Surgical approach including identification of anatomical landmarks, incision, evaluation of the surgical field, debridement of traumatized tissue, lysis of adhesions, and isolation of structures limiting access to the surgical field such as bone, blood vessels, nerve, andmuscles including stimulation for identification or monitoring"

"Because a colectomy requires exposure of the colon, the laparotomy and adhesiolysis to expose the colon are not separately reportable."

 

[ExperiencedDPM]

For future readers, this appears to come from CMS NCCI Chapter 1, Section B

https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-1.pdf

"Many NCCI PTP edits are based upon the standards of medical/surgical practice. Services that are integral to another service are component parts of the more comprehensive service."

"Surgical approach including identification of anatomical landmarks, incision, evaluation of the surgical field, debridement of traumatized tissue, lysis of adhesions, and isolation of structures limiting access to the surgical field such as bone, blood vessels, nerve, andmuscles including stimulation for identification or monitoring"

"Because a colectomy requires exposure of the colon, the laparotomy and adhesiolysis to expose the colon are not separately reportable."

Exactly. Excellent job grasshopper.

 

[PODIATRYCRAZE]

HPI: You graduated residency recently and are used to doing office codes. While starting your own practice you decided to pick up some nursing home shifts. This healthy 90F has good pulses and sensation, but is also partially blind so she cannot take care of her own feet. She does not walk much but when she does she points to calluses on her feet that cause her pain.

Treatment: During your visit she got 10 of her nails cut, and bilateral submetatarsal 1 and 5 callus debrided. Shoe education provided, and some felt cut outs for her insoles.

 

[PODIATRYCRAZE]

ICD: B35.1 Onychomycosis
L85.1 Hyperkeratotic lesions on feet
M79.67 Pain in feet

CPT: 99304 Nursing home visit
11721 Toenail debridement
11056 Callus debridement 4 lesions

Reimbursement: $100? For the callus code I was told L84 will not justify getting paid, so you should use L85.1. Any experiences? Nursing home visit codes are different from both office visits, and house calls. Previously I was told not to code for the toenail or callus debridements if they do not have class findings because it is considered fraud. People say not billing for it is underbilling and that is also considered fraud. Cannot find a definitive guide on this. For the pain in feet code, it is bilateral so I left it unsided, which I have also been told will cause a rejected payment. But since I already have 2 good diagnosis codes it should be justified.

 

[Hybrocure]

ICD: B35.1 Onychomycosis
L85.1 Hyperkeratotic lesions on feet
M79.67 Pain in feet

CPT: 99304 Nursing home visit
11721 Toenail debridement
11056 Callus debridement 4 lesions

Reimbursement: $100? For the callus code I was told L84 will not justify getting paid, so you should use L85.1. Any experiences? Nursing home visit codes are different from both office visits, and house calls. Previously I was told not to code for the toenail or callus debridements if they do not have class findings because it is considered fraud. People say not billing for it is underbilling and that is also considered fraud. Cannot find a definitive guide on this. For the pain in feet code, it is bilateral so I left it unsided, which I have also been told will cause a rejected payment. But since I already have 2 good diagnosis codes it should be justified.

Real answer is a 90 year old in a nursing home doesn’t have palpable pulses

 

[PODIATRYCRAZE]

HPI: 61M has been admitted for foot infection. You saw him and billed a consult code 99222. Initial appearance was just cellulitis, nothing on XRay.

Treatment: You ordered an ultrasound overnight just in case there was abscess. Abscess is found but you cannot do surgery today. You schedule for incision and drainage tomorrow.

 

[PODIATRYCRAZE]

ICD: L03.119 Foot cellulitis
L02.61 Foot Abscess

CPT: 99232 Inpatient rounding (not consult)

Reimbursement: $50? Just like how there is a difference between initial office visit 99203 and subsequent 99213, inpatient has 99222 and 99232.

 

[air bud]

ICD: L03.119 Foot cellulitis
L02.61 Foot Abscess

CPT: 99232 Inpatient rounding (not consult)

Reimbursement: $50? Just like how there is a difference between initial office visit 99203 and subsequent 99213, inpatient has 99222 and 99232.

This is level 3 inpatient bro.

1 acute or chronic illness or injury that poses a threat to life or bodily function👍

Data- you are going to order/review/Independently evaluate enough labs notes x-rays (sed rate CRP, x-ray, read hospitalist and ER notes) AND talk to some other providers (hospitalist maybe ID or vascular) about this case (need both)

Decision regarding emergent major surgery

You satisfied all 3 categories.

AND you are probably going to do a bedside I and D and bill for that. Honestly not sure if can do both. Obviously zero day global on that so OK for OR following day.