CPT

“What is the proper CPT code for percutaneous capsulotomy and tenotomy of metatarsophalangeal joint?”

“I am a young physician and the practice that I am currently at codes almost all routine foot care patients as the following: 1. Tinea ungium B35.1, 2. Peripheral Vascular Disease (PVD) I73.9, 3. Pain in left toe. Documentation is all the same: “All nails are thickened, discolored, and painful with subungual debris” with CPT 11721. Basically, there is no individual nail documentation and all nails are always painful with PVD. This includes younger, disabled patients who present with some thickened nails. I was under the impression that you have to document individual nails and that pain alone is a qualifying diagnosis for nails, if used as the secondary code. My question is: wouldn’t coding only CPT 11721, with pain and PVD to all toes all the time raise red flags?”

“After watching some E/M presentations, it was suggested that hospital consultations should be billed with CPT 99252-CPT 99255. When we billed these codes, our EMR system and our clearing house rejected the codes. They are saying effective 1/1/2010, CMS has announced that they will reject these codes. Are we billing the right codes?”

“What constitutes the difference between CPT 10120 and CPT 10121 – simple subcutaneous versus complicated subcutaneous foreign body removal? Take for example a patient is seen in the clinic with a splinter that I was unable to retrieve simply. Instead, it required local anesthesia and deep probing but no incision or suturing. I removed a 2 centimeter wood splinter. It was subcutaneous, it was “more complicated” than a typical splinter to retrieve (needing local and more than usual probing) yet really wasn’t THAT complicated. How do you define complicated in this case? RVU values for CPT 10121 versus CPT 10120 seem to indicate there are very real differences between the two codes.”

“How do you code for a hospital consultation when the patient is in the postoperative global period from another surgeon? I was called to the local hospital to see a patient that was transferred for medical treatment for an unrelated condition. He had a transmetatarsal amputation (TMA) performed for apparent osteomyelitis at the other hospital by a different podiatric surgeon. I was consulted to evaluate the TMA site and make recommendations for management. How do I code the diagnosis and E/M for this post-operative consultation?”

“I saw an established patient who returned to the office for “At Risk,” Routine Foot Care. The patient also had a new complaint of heel pain. I obtained X-rays of the foot and gave a steroid injection into the heel. Can I bill for the “At Risk,” Routine Foot Care and those additional treatments as well?”

“I have a patient who returns to the office for recurrent six intractable porokeratosis. I have treated this situation for the patient about three months previously and I billed CPT code 17110 after treating it with an application of Cantharone. Can I bill CPT 17110 at this second visit?”

“We performed a heel injection on the right foot for a patient with plantar fasciitis. I used CPT 20550 -RT. UnitedHealthcare denied the claim stating we could not prove we injected a substance on a CPT code that requires it. I discussed this with the “MARS” auditor and that was her comment. Any suggestions on why this was denied and how to correct it?”

Can CPT codes 11730 and 11750 be billed together on the same toe as part of the same procedure?

Fractures, Dislocations, Casts, and Splints