Orthopedic Coding Alert

"When the excision of a heel spur is complicated by associated conditions, comprehensive documentation
of those conditions and the added procedures and supplies needed to treat them will lead to appropriate reimbursement.

The coding for the removal of a heel (calcaneus) spur [see box on page 5] is uncomplicated. Code 28119 (ostectomy, calcaneus for spur, with or without plantar fascial release) serves if a bona fide spur is eliminated. (The code applies whether or not the procedure also includes an effort to release stress on an irritated plantar fascia with [simple] incisions on either side of the ligamenti.e. fasciotomy.) If a piece of the calcaneus is removed instead of a spur, the procedure is coded 28118 (ostectomy, calcaneus).

But a precise code for a procedure does not mean all possible coding opportunities have been exhausted. A closer look at heel excision illustrates the point.

What Else Can be Billed?

The 28000 procedure codes include dressings or casts applied at the time of surgery. The hospital bills for the DME (durable medical equipment), with one exception. If the physician takes a boot from the office for use in the operating room, the physician can bill for it, explains Pat Yarborough, CPC, an independent coding consultant with R& R Specialists in Charlotte, N.C. Other coders agree.

We often take our own Unna boot to the operating room, says Robin Owens, CPC, a coding specialist, also in Charlotte, N.C. She says, Normally, a walking cast is applied at the time of surgery. It's routine in our practice. It is very rarely after-the-fact [that the walking cast is applied].

If the cast is damaged and must be reapplied in the office, it can be billed. Of course, you can't bill the office visit, which will still be under the global, Owens says.

If a truly unusual circumstance necessitates the change of a cast, it should be reported with a -22 modifier (unusual procedural services). Otherwise, a change during the global period requires a new diagnosis code, such as a pressure ulcer due to the cast707.0 (decubitus ulcer, an ulcer of the skin caused by prolonged pressure). The cast change also should be coded (V53.7).

Note: See page 93 of the December 1999 Orthopedic Coding Alert for the article Getting Reimbursed for Applying Casts and Splints.

When the Physician Bills for Supplies

When a physician applies a new cast for medical reasons, or in rare instances, puts the first cast on in the office, a variety of miscellaneous supplies can be charged. For example, tape of all types and sizes can be billed (A4454). So can adhesive remover or solvent, per ounce (A4455).

There are two important things [...]