Podiatry Coding & Billing Alert

Your documentation must support the clinical reasons for breaking Correct Coding Initiative bundles.

If your podiatrist is in the habit of coding wound explorations separately from foreign body removals, he'd better break that habit quickly -- or risk running afoul of the Correct Coding Initiative (CCI).

CCI version 17.3, which takes effect Oct. 1, offers 1,380 new edit pairs and 835 terminated bundles, according to an analysis by Frank Cohen, MPA, MBB, principal and senior analyst with The Frank Cohen Group, LLC. As was the case with the previous CCI edition, the majority of edits impact the codes from the musculoskeletal code range (20000-29999).

This round of CCI edits specifies that CPT® code 20103 (Exploration of penetrating wound [separate procedure]; extremity) is now included in:

• 28190 (Removal of foreign body, foot; subcutaneous)
• 28192 (... deep)
• 28193 (... complicated).

Background: Generally, explorations of this type occur when the patient experiences a "penetrating" trauma, such as a stab wound or gunshot. The podiatrist assesses the extent of damage to the tissues by the penetrating wound as he explores it. Treatment may follow to include cleansing, debridement, removal and repair of damaged tissue, removal of foreign body if any, ligation and repair of small blood vessels in subcutaneous tissues and fascia, and finally, the closure of the wound.

Modifier 59 May Enable Separate Payment

These new CCI edits are marked with a "Modifier Indicator" of "1," which means that you may use a modifier to override the edit if clinical circumstances warrant separate payment.

Tip: The most common modifiers that Part B practices use to override an edit pair are 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when used with an associated E/M code, or modifier 59 (Distinct procedural service) when two non-E/M services are performed and no other modifier is available to report the two separate and distinct services, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, Director of Hospital and Network Oversight at Mount Sinai Medical Center Compliance Department in New York City.

"Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual," Mac says. "However, when another already established modifier is appropriate, it should be used rather than modifier 59."

For more on CCI edits and to find which ones impact your practice, visit the CMS web site at www.cms.gov/nationalcorrectcodinited/ncciep/list.asp.