Internal Medicine Coding Alert

Question: What is an Unna boot and how should I bill for it?

Michigan Subscriber

Answer: Typically, physicians use an Unna boot dressing to treat varicose veins of the lower extremities when the patient has an ulcer (454.0) in this area. The boot's pressure and bacteriostatic properties help heal the leg. Physicians can also use Unna boots to manage lymphatic edema, sprains, strains, minor fractures and as a protective bandage for grafts on burn wounds. When billing for an Unna boot, report 29580 (Strapping; Unna boot). Code 29580 includes supplies associated with the boot treatment.
 
Medicare payers vary with Unna boot coding guidelines. Many carriers, such as HealthNow in New York, will only pay for the treatment service, not the removal of strappings, cast or other dressings. Therefore, you probably won't be able to report 29700 (Removal or bivalving; gauntlet, boot or body cast).
 
Make sure you check your local Medicare insurer's approved ICD-9 codes. Noridian Administration Services in North Dakota, for example, only pays for Unna boot services when the physician treats varicose ulcers of the lower extremities (454.0) or a strained ankle (845.0x), not fractures (824.x, Fracture of ankle) or varicose veins without ulcers (454.x). For the initial office visit that led to the Unna boot treatment, you can report the appropriate E/M code, such as 99213 (Office or other outpatient visit...established patient), in addition to 29580. But you shouldn't bill an E/M service for subsequent treatments unless the documentation proves the physician performed an E/M service for an unrelated condition. In that case, use modifier -25 (Significant, separately indentifiable evaluation and management service by the same physician on the same day of the procedure or other service).