Podiatry Coding & Billing Alert

Make sure the documentation supports use of 76881 vs. 76882.

From orthotic and prosthetic management changes, to ultrasound revisions, to evaluation and management (E/M) updates, CPT^® 2018 will have an impact on your podiatry coding. Make sure you're ready when all of these new, deleted, and revised CPT^® codes go into effect.

Take the following quiz to stay in step with all you need to know about CPT^® 2018.

Zero in on These Revisions for 97760 and 97761

Question 1: What revisions should we expect to see for orthotic and prosthetic management?

Answer 1: CPT^® 2018 will bring revised descriptors for orthotic and prosthetic management codes 97760 and 97761. They are as follows:

• 97760 (New descriptor effective January 1:  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 (New descriptor effective January 1: Prosthetic training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes).

Mark Down New Code 97763

Question 2: What is the new orthotic and prosthetic management code for 2018?

Answer 2: In 2018, you will have 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) as a new choice for orthotic and prosthetic management.

Factor In These Ultrasound Changes

Question 3: How will 76881 and 76882 change for CPT^® 2018?

Answer 3: Ultrasound codes 76881 and 76882 will see some revisions for 2018.

First of all, the preamble to the extremities codes in CPT^®'s ultrasound section has been expanded significantly. The notes now indicate that 76881 (New descriptor as of January 1: Ultrasound, complete joint (i.e., joint space and periarticular soft-tissue structures), real-time with image documentation) "requires ultrasound examination of all of the following joint elements: Joint space (e.g., effusion), peri-articular soft tissue structures that surround the joint (i.e., muscles, tendons, other soft-tissue structures), and any identifiable abnormality."

To report the complete code 76881, you must also permanently record the images and maintain a written report with a description of each element visualized "or reason that an element(s) could not be visualized (e.g., absent secondary to surgery or trauma)," CPT^®  says.

If you don't perform the elements required by CPT^®, you should instead report the limited study code, 76882 (New descriptor effective January 1: 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), real-time with image documentation).

To submit 76882, CPT^® requires a limited evaluation including "assessment of a specific anatomic structure(s) (e.g., joint space only (effusion) or tendon, muscle, and/or other soft-tissue structure(s) that surround the joint) that does not assess all of the required elements included in 76881," the manual will now state.

Tip: When submitting codes 76881 and 76882, you need to ensure that there is documentation to support what structures were assessed during the ultrasound. You need to maintain the written reports of all ultrasound studies in the patient's record. This report should be detailed enough to support the choice of codes for a procedure.

How to record? You may adopt either of the following ways to record:

• For ultrasound guidance procedures, the written reports may be filed as a separate item in the patient's record or included within the report of the procedure for which the guidance is used.
• You can store records as printed images or on a tape or electronic medium that's kept in the patient record or some other archive (they are not required to be submitted with the claim). You may have to produce these documents if the insurer requests you to do so.

Don't Miss This E/M Revision

Question 4: What words will the 99217-9920 add to their descriptors?

Answer 4: Beginning in January, for the initial observation E/M codes 99217-99220 (Initial observation care, per day, for the evaluation and management of a patient...), you will see the inclusion of the term "outpatient hospital" to describe the patient's observation status. For example, a portion of the description for code 99217 will change to "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.'"

"These changes appear to be clearing up the confusion that often arises with observation patient status," says Barbara J. Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, AAPC Fellow, vice president at Stark Coding & Consulting LLC, in Shrewsbury, New Jersey. "Essentially, CPT® is clarifying that patients that are in observation are always in an outpatient status," Cobuzzi explains.