Podiatry Coding & Billing Alert

The latest round of Correct Coding Initiative edits will also change the way you bill for synovectomy.

If you're in the habit of reporting the freeing of a tendon from adhesions along with foot surgeries involving the flexors and extensors, you may need to break that habit now, or risk denials.

The Correct Coding Initiative (CCI) released version 17.1 effective April 1, revealing 11,831 new edit pairs and 346 terminations, said Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions, Inc., in a March 17 statement.

The edit pairs identify codes that coders should not report together for the same patient on the same date of service. Most of the edits in this version are "Column 1/Column 2" or "Comprehensive/Component" edits, which means that CCI considers the code in Column 2 of the edit pair to be an intrinsic component of the comprehensive procedure, which appears in Column 1.

Effective April 1, CCI 17.1 bundles tenolysis codes 28220-28222 (Tenolysis, flexor, foot ...) and 28225-28226 (Tenolysis, extensor, foot ...) into dozens of foot surgery codes, including:

What this means: CCI has determined that tenolysis -- the surgical release of a tendon from adhesions -- is an intrinsic part of these surgeries involving the flexors and extensors of the foot, and payment for the tenolysis procedures should be included in the payment for the comprehensive procedure.

CCI marks these bundles with modifier indicator "1," which allows you to report two bundled codes separately under appropriate clinical circumstances, with an appropriate modifier.

Example: The podiatrist performs tenolysis on the right foot and arthrotomy on the left foot. You can report the two procedures together as 28220-RT and 28020-59-LT.

Watch for Synovectomy/FBR Bundling

Synovectomy codes 28070 (Synovectomy; intertarsal or tarsometatarsal joint, each) and 28072 (... metatarsophalangeal joint, each) are now bundled into foreign-body removal codes 28190-28193 (Removal of foreign body, foot ...). Because the bundles are marked with modifier indicator "1," this means you can no longer bill separately for a partial removal of synovial membrane along with a foot FBR unless clinical circumstances require it (for instance, the synovectomy and FBR were performed on different feet) and you append the appropriate modifiers (such as modifier 59 or LT/RT).

Also, CCI 17.1 bundles tendon sheath synovectomy procedures 28086-28088 (Synovectomy, tendon sheath, foot ...) into dozens of foot surgery codes, including;

CCI marks all of the above bundles with modifier indicator "1," allowing you to break the bundles with an appropriate modifier.

Mark Arthrotomy, I&D Changes, Too

Arthrotomy codes 28020-28024 (Arthrotomy, including exploration, drainage, or removal of loose or foreign body ...) are now bundled into codes 28046-28047 (Radical resection of tumor [e.g., malignant neoplasm], soft tissue of foot or toe ...)

Also, code 28001 (Incision and drainage, bursa, foot) now includes 28190, 28192, and 28193 (Removal of foreign body, foot ...)

Resource: To read more about CCI edits, visit the CMS Web site. You can find the current listing of CCI edits, as well as the CCI policy manual, at www.cms.hhs.gov/NationalCorrectCodInitEd.

You can also check any specific code for CCI bundles at https://www.aapc.com/codes/.