General Surgery Coding Alert

Question: Our surgeon recently applied an Unna boot for a patient with decubitus ulcers. I-ve never coded this service before. Can I report an E/M service in addition to the boot application?

Washington Subscriber

Answer: In most cases, you should not report an E/M service at the same time as an Unna boot application (29580, Strapping; Unna boot). A typical Medicare local coverage determination will specify, "Unless a separate and distinct service is performed other than CPT 29580, an E/M in addition to CPT 29580 is noncovered."

If the patient has a new or different complaint that necessitates a separate and significant E/M service, you may report an appropriate E/M service (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient ...) appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). You should attach a separate diagnosis to the E/M service to further differentiate it from the inherent E/M service included in the Unna boot application.

Most payers will cover the procedure for a very limited number of diagnoses, including varicose veins of lower extremities (454.0-454.2) and lower limb ulcers, except decubitus (707.10, 707.12-707.19). Some payers will accept additional diagnoses, such as atherosclerosis of extremity with ulceration (440.23) or sprains and strains of the ankle and foot (845.00-845.19).

Good idea: Covered diagnoses for Unna boot applications vary greatly from insurer to insurer, so you-ll have to look to your individual payer for guidance. Payers often update their policies, so you should check with them from time to time for any additional information.

In addition, you should not bill separately for supplies when reporting 29580. Medicare and other payers will pay separately for casting and splinting supplies, but Unna boots do not fall into this category. Instead, payers include the cost of all Unna boot supplies (bandages, straps and paste) in their payment for 29580.

You cannot report a separate service for removing the Unna boot. Coders sometimes mistakenly report 29700 (Removal or bivalving; gauntlet, boot or body cast) for this service, but this is incorrect. Noridian Medicare, for instance, specifically instructs, "Removal of Unna boot is not a separately reimbursable service. Code 29700 is not appropriate to report this service."

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program.