Podiatry Coding & Billing Alert

The latest version of the Correct Coding Initiative (CCI) edits took effect on Jan. 1, -- and you might be surprised to find new CPT excision and wound compression system codes bundled with a long list of podiatry procedures.

CCI 16.0 provides more than 24,060 new active pairs of medical procedures. The edition includes 869 modifier changes and 19,083 terminated pairs, according to Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc. Increase your chances for payment success by familiarizing yourself with the new code pairs that apply in podiatry.

You'll find several new bundles for the new and revised excision codes your podiatrist might use. You won't be able to report other procedures such as debridement (11040-11044 -- Debridement; skin, partial thickness) and repair (12001-12047 -- Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]...). Among the 2010 excision codes paired as column 1 items with debridement and repair procedures are:

• 11400-11426 -- Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia ...

• 27615 -- Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or ankle area; less than 5 cm.

• 27618-27619 -- Excision, tumor, leg or ankle area ...

• 28039 -- Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater

• 28171"28175 -- Radical resection of tumor, bone; tarsal (except talus of calcaneus) metatarsal Most of the excision codes are mutually exclusive of debridement/repair codes. CCI is operating on the theory that a physician would not reasonably perform both procedures for a patient during one session.

Example: CCI lists 27619 (Excision, tumor, soft tissue of leg or ankle area, subfascial [eg, intramuscular]; less than 5cm) as mutually exclusive of 11043 (Debridement; skin, subcutaneous tissue, and muscle). The podiatrist could not, in the same session, remove skin and muscle tissue from the same area where a tumor has just been excised.

Take note: When billing mutually exclusive codes, make sure that you code accurately for the service or services your podiatrist performed and attach the appropriate modifier. When billing a bundled code with a "0" modifier indicator, you will want to bill for the highervalued procedure, assuming your podiatrist's documentation supports that code. If you bill both codes, most likely your payer will either deny the whole claim or pay for whatever code you billed first.

When billing bundled codes with a "1" modifier indicator, you will have to establish the need to perform the separate procedures in order to get reimbursement. Place the modifier on the column 2 code. If your podiatrist's documentation does not support separate procedures, however, simply report one code to avoid a claims denial.

You will also find a slew of bundles between podiatry procedure codes and the new wound compression system code 29581 (Application of multi-layer venous wound compression system, below knee). Among those paired with 29581 are:

• 11730-11732 -- Avulsion of nail plate, partial or complete, simple ...

• 28238 -- Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure)

• 28285 -- Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)

• 28292 -- Correction, hallux valgus (bunion), with or without sesamoidectomy; Keller, McBride, or Mayo type procedure.

In the above pairings, CCI lists 29851 as a column 2 code, which means that it is considered a component of the more comprehensive code under column 1. These bundles have a modifier indicator of "1."

Therefore, you may use a modifier, such as 59 (Distinct procedural service), to override the edit if the clinical circumstances warrant separate reimbursement, such as a separate encounter on the same date, a separate anatomical site, or a separate indication.

Example: A patient sees a podiatrist for treatment of a wound on his leg following a skateboarding accident. The podiatrist administers a wound compression system on the leg wound (29581). During the same session, the physician discovers a diseased nail on the big toe of the injured foot. He decides to partially avulse the infected nail plate (11730 -- Avulsion of nail plate, partial or complete, simple, single). In this case, the podiatrist performed the wound compression (29581) as a separate and unrelated procedure.

You can, therefore, override the CCI edit and bill both procedures separately by appending modifier 59 to 11730, according Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC of Hampton, Va.