Podiatry Coding & Billing Alert

Hint: Code 76881 includes real-time ultrasound scans of a joint.

It's CPT^® update season once again, and you don't want to fall behind. Make sure you're ready and know how the latest revisions, deletions, and additions will impact your podiatry practice.

Bottom line: These changes will go into effect on January 1, 2018.

Dig Into These Orthotic and Prosthetic Management Updates

CPT^® 2018 will bring several changes to the "Orthotic Management and Prosthetic Management" section.

Deletion: Currently you can report 97762 (Checkout for orthotic/prosthetic use, established patient, each 15 minutes). However, this code will no longer be valid after January 1, 2018, as CPT^® 2018 will delete it.

Addition: In 2018, you will be able to look to new code 97763 (Orthotic[s]/prosthetic[s] management and/or training, upper extremity[ies], lower extremity[ies], and/or trunk, subsequent orthotic[s]/prosthetic[s] encounter, each 15 minutes).

Regarding the CPT^® changes, you should always review the list of codes and take note of deleted codes you may have used in the past, says Arnold Beresh, DPM, CPC, CSFAC in Newport News, Virginia.  

You should also discuss the changes with the physician and know how the definitions will affect billing, especially the charting of procedure notes, Beresh adds.

Revisions: Two of the existing codes for orthotic and prosthetic management will see some revisions (emphasis added):

• 97760 (Orthotic[s] management and training [including assessment and fitting when not otherwise reported], upper extremity[s], lower extremity(ies) and/or trunk initial orthotic[s] encounter, each 15 minutes)
• 97761 (Prosthetic training, upper and/or lower extremity[ies], initial prosthetic[s] encounter, each 15 minutes).

These revisions will add more specificity, Beresh says.

Example: During an office visit, the podiatrist trains the patient on how to use an orthotic device on his foot. The podiatrist also assesses and adjusts the fit of the device. In addition, the podiatrist develops a treatment plan based on his assessment of the patient's needs and functional ability.

If the podiatrist spends at least 15 minutes of direct one-on-one contact with the patient, then you can report 97760.

Take a Look at These Ultrasound Revisions

In 2018, two ultrasound codes will see some revisions (emphasis added):

• 76881 (Ultrasound, complete joint [ie, joint space and peri-articular soft tissue structures] extremity, nonvascular, real-time with image documen­tation; complete)
• 76882 (Ultrasound, limited, joint or other nonvascular extremity structure[s] [eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]] extremity, nonvascular, real-time with image documentation; limited, anatomic specific).

Caution: Use care when reporting 76881 and 76882. Code 76881 includes real-time ultrasound scans of a joint. To be complete, the documentation should reference related "muscles, tendons, joint, other soft tissue structures, and any identifiable abnormality."

On the other hand, 76882 applies to the examination of a specific anatomic structure, including a muscle, tendon, joint, or other soft tissue. For example, you may see a limited exam for an Achilles tendon injury.

Code 76882 is also appropriate for a soft-tissue mass evaluation. In this case, the podiatrist may be investigating the mass to explore its cystic or solid characteristics.

Expert tip: When reporting 76881 and 76882, Beresh cautions coders to make sure they choose the correct code for a complete versus a partial exam.

Catch This Hospital Observation Care E/M Language Change

If you report hospital observation codes 99217 and 99218-99220, you should note this evaluation and management (E/M) language change. All of the descriptors for these codes will add the phrase "outpatient hospital."

Revisions: Take a look at 99217 (emphasis added):

• 99217 (Observation care discharge day management [This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." ...)

This change also holds true for initial hospital observation care services 99218 (Initial observation care, per day, for the evaluation and management of a patient ... Usually, the problem[s] requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.) through 99220 (... Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of high severity. Typically, 70 minutes are spent at the bedside and on the patient's hospital floor or unit).

According to Suzan Hauptman, MPM, CPC, CEMC, CEDC AAPC fellow, senior principal of ACE Med Group in Pittsburgh, this revision further clarifies where these services should be rendered as they related to these code choices. Observing a patient can be accomplished in both an inpatient setting as well as an outpatient setting; it is dependent on the patient's condition. These codes are only to be used when the patient is admitted as an observation patient.