Coding

"My associate doctor recently billed for a hospital outpatient surgery on 08/13: 28005 and 11981. The antibiotic spacer kept displacing during the post op period, so he went back earlier than expected on 10/2 to do the following, hence the patient is still in the global period from the first procedures:" in the following article.

One of the more frustrating parts of practicing medicine is dealing with insurance company billing and coding requirements. We perform a service that is medically necessary, document the care provided, submit the claim, and sometimes receive a denial because we failed to meet an insurance company's particular requirements. AI can help physicians and their staff research these policies, identify the requirements that apply to a particular service, and locate the actual documents published by the insurance company. This is one of the practical ways AI can help reduce the administrative burden of running a medical practice.

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“Can I still bill one of the hallux valgus correction codes if I don’t excise the medial aspect of the head of the 1st metatarsal even if I correct the IM angle?”

The annual ICD-10-CM update takes effect October 1, and FY 2027 brings several changes that are particularly relevant to podiatric medicine. Although the overall number of ICD-10-CM changes is substantial, the number of changes directly affecting podiatry is relatively limited.

“Does writing or managing a prescription with moderate-complexity medical decision-making (MDM) for an established patient in a podiatric office qualify for CPT code 99214? Furthermore, if this is correct, do CPT codes 99309 (nursing facility) and 99349 (home or residence visit) apply under the same MDM criteria, and why might those specific site-of-service codes be inapplicable depending on the setting or patient status?”

“We have a provider who wants to do Qutenza patches for neuropathy affecting a patient’s foot. The vendor suggested CPT code 64632. I cannot find anything official to support that code and most of the carriers that do have policies state that there is no CPT code for the application and to list the J code for the medication. Do you have any insight here or anything official that states that CPT code 64632 would be appropriate?”

“Three of the podiatrists in our group have joined together to open a wound care center. They have a licensed LVN on staff that performs wound dressing changes, Arobella wound care treatments and things of that nature. Are we able to charge the E/M code 99211 as a "nurse" visit if the doctor is not on site? Any advice or recommendations are greatly appreciated.”

“I did a house call yesterday on a patient under at-home hospice care. She had a diabetic wound on the foot that I provided care for. I also did routine care as she has Q7 findings. She is covered by an Aetna Medicare Advantage Plan. I have a couple of questions.