CPT

“I am in Virginia and I have read through the LCD and billing guidelines for Palmetto GBA several times regarding coverage for routine foot care. It is very specific about when CPT 11720 and CPT 11721 will be covered, but it is not specific about CPT 11055, CPT 11056 and CPT 11057. My interpretation is that for coverage of CPT 11055-CPT 11057, there must be a systemic condition with class findings and if there are no systemic conditions that would qualify for coverage, modifier -GY should be used and -GA if an ABN is on file. I am wondering if CPT 11055-CPT 11057 are also covered with primary diagnosis code of L85.1 with appropriate secondary diagnosis similar to how CPT 11720 and CPT 11721 are covered for mycotic nails with primary diagnosis of B35.1 with appropriate secondary diagnosis. Are callus codes (CPT 11055-CPT 11057) covered with the primary diagnosis of L85.1 (or similar) and a secondary diagnosis of infection, pain, or difficulty walking? Or are they only covered with systemic conditions and class findings?

CPT code 11755 is defined as the following: Biopsy of nail unit (e.g. plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure). It is amazing to me how often this CPT code is misused and abused.

“The original procedure that was performed was a hallux interphalangeal joint arthroplasty to resolve a medial, diabetic ulcer. An infection developed that led to a hallux amputation. Does the global of the first surgery (arthroplasty) stay in place or is it reset by the zero-day global for the second surgery (amputation)?”

The Proper Use of the 25 Modifier

“My documentation for qualified, routine foot care is similar for most patients as little changes in 3 months. But, yes, I do look for changes and make the note reflect such. And I try to make sure notes are not exact copies of previous notes. My notes have plenty of bullet points for an E/M code on each visit. I am primarily charging procedure codes only (CPT 11056, CPT 11721, etc). Can I still bill at least one E/M code per year even when there are no substantive changes as I continually monitor vascular, neurologic and dermal changes each visit? Must I have a new or different diagnosis to bill an E/M code?”

“I have a patient who had a chevron bunionectomy performed 10 years ago. The bunion has returned, and the head is facing lateral. My plan is to perform a Lapidus procedure to reduce the first intermetatarsal angle and a rotational 1st metatarsal head osteotomy to align the articular surface (basically an Austin with a medial based wedge removed from the dorsal osteotomy to rotate the head slightly medial). How would you recommend I code this (ICD-10 and CPT codes)? Can I use CPT 29297 and CPT 29296? I’ve also considered CPT 28740 with CPT 29296.“

“Medicare pays approximately $40 more for E/M code 99213 versus an injection for a neuroma. Can you give the injection and only bill the E/M 99213?”

“In many cases requiring an arthroplasty of the proximal interphalangeal joint (PIPJ) 5th digit (especially when associated with a heloma molle), I often do an arthroplasty PIPJ, flexor lengthening and a partial syndactylization (advancing the webspace but differently than the description of Ruiz-Mora). I have always simply billed for an arthroplasty PIPJ 5th toe. Now I have been forced to pay attention to coding because of my EMR program. Should I have been billing this differently for all these years?”

In order to bill 28292, 28295, 28296, 28297, 28298, 28299, the medial aspect of the head of the 1st metatarsal MUST be excised/removed in addition to any additional procedures that are performed to correct the hallux valgus deformity to justify and support the CPT code that is billed.

The AMA has approved significant changes to the 2026 CPT book for Remote Monitoring Codes. If you are providing Remote Therapeutic or Remote Physiologic Monitoring, you need to be aware of these code changes. With these changes the burden associated with Remote Monitoring is reduced and you may want to look at incorporating Remote Monitoring into your practice.