Podiatry Coding & Billing Alert

Don’t miss these 38222 PTP edit pair modifier indicator changes.

CMS recently released its quarterly Procedure-to-Procedure (PTP) Correct Coding Initiative (CCI) updates for 2018. CCI 24.2 became effective on July 1, 2018. Although the podiatry updates were light this quarter, you should always take note of the changes whenever they come in.

“My advice is to always check the CCI edits for each and every procedure reported,” says Dolly Perrine, CCS-P, CPC, CPC-I, CUC, CPMA, auditor and educator of professional services at St. Charles Health System in Bend, Oregon.

Mark Down This Arthodesis, Hammertoe Correction Update

There is now a CCI edit for the 28750/28285 PTP pair. Previously 28750 (Arthrodesis, great toe; metatarsophalangeal joint) was the Column 2 code for 28285 (Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)), but now 28285 is the Column 2 code for 28750.

What this means: If you report both codes of a PTP pair for the same patient on the same date of service, the Column 1 code, 28750, is eligible for payment, but your payer will deny the Column 2 code — 28285.

Modifier indicator: The modifier indicator for the 28750/28285 PTP pair is 1. Although PTP edits show which CPT^® codes you should not report together, under some circumstances, you can use a modifier to override the edits. This is where the modifier indicator comes in.

The modifier indicator of “1” means the edit can be overcome, if appropriate, with the use of a modifier such as modifier 59 (Distinct procedural service), says Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Remember: The documentation and clinical circumstances must always support your decision to use the modifier. Examples include separate sites or sessions for the services. Never append a modifier just to bypass the edit.

Don’t Forget This Debridement, Chemical Cauterization Change

Now, 97597 (Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less), is a Column 1 code for 17250 (Chemical cauterization of granulation tissue (ie, proud flesh)). Previously, 97597 was the Column 2 code for 17250.

The modifier indicator for the 97597/17250 PTP pair is 1.

Notice This Modifier Indicator Change

The modifier indicator for the 78306 (Bone and/or joint imaging; whole body)/A9539 (Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries) PTP pair has changed from 0 to 1. This means that, in the past, the 0 modifier indicator let you know you could not use a modifier to override this edit under any circumstances. But, now, since the modifier indicator has changed to 1, you can overcome this edit, if appropriate, with the use of a modifier.

See These 38222 Modifier Indicator Updates

Code 38222 (Diagnostic bone marrow; biopsy(ies) and aspiration(s)) is a Column 2 code to the following codes:

• 20240 (Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx))
• 20900 (Bone graft, any donor area; minor or small (eg, dowel or button))
• 20902 (Bone graft, any donor area; major or large).

The change: Whereas you could override the 20240/38222, 20900/38222, or 20902/38222 PTP edits with a modifier, when appropriate, now you cannot because the modifier indicator for these edits has changed to 0.