Podiatry Coding & Billing Alert

Although the 2020 CPT^® updates just went to effect on Jan. 1, 2020, you already have some revisions to make to these codes and guidelines. The American Medical Association (AMA) recently released the CPT^® 2020 Errata and Technical Corrections that it made to the 2020 CPT^® manual. The effective date for these updates was Jan. 1, 2020.

Take a look to make sure you are updated on these changes.

Notice Important Revision to Parenthetical Note

AMA has made a revision in the “Surgery Integumentary System Skin, Subcutaneous, and Accessory Structures Pairing or Cutting” section.

For example, AMA will add and delete some information from the parenthetical note preceding code 11055 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion). The change will be as follows: “To report destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions, see 17000-17004 17110, 17111).” (Emphasis added.) These revisions give clarity to which codes you should report for destruction of benign lesions other than skin tags or cutaneous vascular proliferative lesions. You should report this type of destruction with codes 17110 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions) or 17111 (… 15 or more lesions).

Don’t miss: When you report these destruction codes, you must know what type of lesion the podiatrist performed the destruction on. Codes 17110 or 17111 specify that the lesion must be a benign lesion other than skin tags or cutaneous vascular proliferative lesions. Before this revision, the guidelines mentioned codes 17000 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion)-17004 (Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions), which are for the destruction or premalignant lesions.

Errata Fixes Typo in Index

AMA will also fix a minor error in the index under “Foot.” If you look at “Foot,” then “Tendon,” then “Lengthening,” you will see a mistake with the correct codes

The errata fixes the codes so that they correctly read 28261 (Capsulotomy, midfoot; with tendon lengthening)- 28262 (Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot deformity)), not the original 28621-28262. The original code range was a typo because there is not a code 28621 in the CPT^® manual.

Observe Descriptor Changes to New Codes

AMA will also make some changes to the descriptors for new codes 98970-98971.

Take a look at this example: 98970 Qualified nonphysician health care professional online digital evaluation and management service assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes. (Emphasis added).

As you can see, AMA has removed “evaluation and management service” from the code descriptor and added “assessment and management” instead.

Dial Into 99457, 99458 Guidelines Revisions

You will see some corrections to the CPT^® guidelines for 99457 (Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes) and new code +99458 (… each additional 20 minutes (List separately in addition to code for primary procedure)).

Take a look at the changes. (Emphasis added.) “For the first completed 20 minutes of clinical staff/physician/ other qualified health care professional time in a calendar month report 99457, and report 99458 for each additional completed 20 minutes,” per the guidelines. “Do not report 99457, 99458 for services of less than 20 minutes. Report 99457 one time regardless of the number of physiologic monitoring modalities performed in a given calendar month.”

Bottom line: AMA has revised the “Remote Physiologic Monitoring and Treatment Management Services” guidelines to specify that you should report 99457 for the first completed 20 minutes of clinical staff/physician/ other qualified health care professional time in a calendar month. Also, you should report +99458 for each additional completed 20 minutes, per the revisions.

Code +99458: You will also see some revisions to the parenthetical notes for new code +99458. For example, the second parenthetical note has been completely deleted. (Emphasis added): (Report only 99457 if you have not completed 20 minutes of additional treatment regardless of time spent).

AMA has also revised the third parenthetical note for +99458. Now the guidelines specify that you cannot report +99458 for “services of less than an additional increment of 20 minutes.” (Emphasis added.) This revision clarifies how important it is to document the exact time when reporting 99457 and +99458.

You should report 99457 for the first 20 minutes of remote physiologic monitoring treatment management services. When reporting +99458, you must check the documentation to make sure that the provider performed an additional 20 minutes of this service. Code +99458 is an add-on code, so you must always report it in conjunction with primary code 99457, which explains how the words “an additional increment” add clarity to this reporting rule.

Add-on codes: You should never report an add-on code like +99458 as the primary code for a procedure on your claims. Add-on codes are always reported with an appropriate primary code. Add-on codes are identified with the special symbol “+.”

“This is a feature of add-on codes that some people forget,” says Gregory Przybylski, MD at the JFK Medical Center in Edison, New Jersey. “One cannot report an add-on code unless the valid primary code (to which the add-on code is associated with) is also reported. CPT^® lists the specific primary codes to which add-on codes may be used if that service is performed.”