Podiatry Coding & Billing Alert

If your podiatrist doesn't diligently document tumor size, you'll start losing reimbursement.

CPT Codes 2010 offers you several new tumor removal codes you'll need to use when your podiatrist treats tumors on a patient's leg or ankle.

Base Your Code Choice on 3 Questions

CPT categorizes the new excision codes according to size, location, and malignancy.

You'll choose the excision code based on the following criteria:

1. Is the excision a radical excision -- in other words, is the tumor malignant?

2. Is the tumor removal subcutaneous, subfascial, intramuscular, or deep?

3. What size is the tumor your podiatrist removed?

Existing leg and ankle tumor excision codes 27615 (Radical resection of tumor [eg, malignant neoplasm], soft tissue of leg or ankle area; less than 5 cm), 27618 (Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm), and 27619 (Excision, tumor, soft tissue of leg or ankle area, subfascial [eg, intramuscular]; less than 5 cm) have additional wording to indicate tumor size. The AMA added several other codes to cover larger sizes:

• 27616 -- Radical resection of tumor (e.g., malignant neoplasm), soft tissue of leg or ankle area; 5 cm or greater.

• 27632 -- Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greater.

• 27634 -- Excision, tumor, soft tissue of leg or ankle area, subfascial (e.g,,intramuscular); 5 cm or greater.

Additionally, for foot or toe tumor excisions, CPT adds size specificity to existing codes 28043 (Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm), 28045 (Excision, tumor, soft tissue of foot or toe, subfascial [e.g., intramuscular]; less than 1.5 cm), and 28046 (Radical resection of tumor (e.g., malignant neoplasm), soft tissue of foot or toe; less than 3 cm). CPT offers you three new foot or toe excision codes, as well:

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

• 28041 -- Excision, tumor, soft tissue of foot or toe, subfascial (e.g., intramuscular); 1.5 cm or greater.

• 28047 -- Radical resection of tumor (e.g., malignant neoplasm), soft tissue of foot or toe; 3 cm or greater.

"The above codes all add greater specificity of size to the removal of lesions benign and malignant neoplasms," says Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC of Hampton, Va.

Documentation essentials: "The key here, though, is to have a conscientious surgeon who will be sure to dictate these findings in his operative report so the coder is successful in utilizing them," says Kristine Newton, CPC, a billing coordinator in Sarasota, Fla. "Knowing the size, depth, and excision versus resection of these tumors will be key in making these new and revised codes work and should enhance the success of appeals with denials in the case of multiple tumors in different areas."

"Until these codes, there has never been a way to express the depth of removing a tumor or tumorous mass except with modifier 22 (Increased procedural services)," says Leslie Johnson, CPC, quality control auditor for Duke University Health System and owner of the billing and coding Web site AskLeslie.net. "In theory, the size of a tumor should fairly well reflect the depth and difficulty in terms of work that has to be done to remove the tumors.

Payment received should be reflective of that work -- more money for more work."

Update Your Wound Compression Arsenal

You'll also have a new code for wound compression systems your podiatrist may use: 29581 (Application of multi-layer venous wound compression system, below knee). The AMA developed this code "in response to new technology for multi-layer venous wound compression systems," Beresh says. He adds that 29581 is "a much better code and more descriptive than just using the unna boot application," which you would report using 29580 (Unna boot).

Important: CPT instructions following 29580 now instruct you "do not report 29580 in conjunction with 29581." Additional notes after 29581 add "do not report 29581 in conjunction with 29540 [Strapping; ankle and/or foot], 29580."

Capture Additional Information With Cat. II Codes

CPT 2010 includes several Category II codes that your practice may use:

• 1159F -- Medication list documented in medical record (COA)

• 1160F -- Review of all medications by a prescribing practitioner or clinical pharmacist (such as, prescriptions, OTCs, herbal therapies and supplements) documented in the medical record (COA)

• 2050F -- Wound characteristics including size AND nature of wound base tissue AND amount of drainage prior to debridement documented (CWC)

• 4260F -- Wound surface culture technique used (CWC)

• 4265F -- Use of wet to dry dressings prescribed or recommended (CWC)

• 4266F - Use of wet to dry dressings neither prescribed nor recommended (CWC)

• 4267F -- Compression therapy prescribed (CWC)

• 4269F -- Appropriate method of offloading (pressure relief) prescribed (CWC).

"I do not know if the codes are payable but they could be useful to help in documentation," Beresh says.

Category II codes help better describe E/Ms and can correlate a patient's disease to the treatment rendered. Although Category IIs are not required, the AMA's intent is to help data mining by coding certain services and/or test results found to be contributing factors to positive health outcomes and quality patient care.

Don't use Category II codes as a substitute for Category I codes. You should always code Category IIs assecondary to the primary procedure code.