Podiatry Coding & Billing Alert

Remember: You must append modifier 59when reporting 27695 for two or more repairs.

Whether you're a brand-new coder or you've been coding for years, you could probably benefit from a quick refresher. Take a look at the following frequently asked questions to make sure you stay up-to-date on common coding questions.

FAQ 1: What Code Should I Report for Primary Ankle Ligament Repair?

Answer: Before coding the ligament repair, review the op notes to capture the number of ligaments and incisions the podiatrist operated on. If the podiatrist makes a fresh repair on any one of the ligament structures - medial or lateral - this is a primary repair. In this case, you should report code 27695 (Repair, primary, disrupted ligament, ankle; collateral).

Caution:  You should report 27695 only once despite the number of the incisions the podiatrist makes to repair the same ligament. If the podiatrist makes multiple incisions to repair a single ligament, still report 27695 only once.

Make sure you pinpoint either the left or right foot by using the correct location modifier, RT (Right side) or LT (Left side), for the repair.

If the podiatrist repairs multiple ligaments within the lateral or the medial, then you can report multiple units of 27695 for each ligament repaired. But, you must append modifier 59 (Distinct procedural service) when reporting 27695 for two or more repairs. The op notes should specify which ligament(s) the podiatrist repaired in the procedure. Make sure the documentation supports the different sites before you append modifier 59.

For example, if the podiatrist repairs multiple ligaments in one of the collateral complexes, such as both the anterior talofibular and calcaneofibular ligaments in the lateral structure, and he makes separate incisions for both ligaments, you will report:

• 27695
• 27695 -59.

FAQ 2: What Does the Wedge Excision Code Entail?

Answer: Code 11765 (Wedge excision of skin of nail fold [eg, for ingrown toenail]) describes when the podiatrist removes the inflamed tissue adjacent to the nail and a section of the nail itself, along the whole length of the nail. It is used as a treatment of a nail bed that has been injured due to laceration, crush, or avulsion, or for pain caused by an ingrown toenail. After administering local anesthesia, your podiatrist makes an elliptical incision through the granulating or subcutaneous hypertrophied tissue of the affected nail groove. A wedge-shaped incision removes soft tissue from the nail margins. Your podiatrist then closes the wound with sutures to promote healing.

Example: A patient is suffering from an ingrown left second-digit toenail. Your podiatrist wedges the nail to treat the ingrowth, removes adjacent tissue, and then packs it with Iodoform gauze. In this case, you should report 11765.

FAQ 3: How Should I Tally "All Others Negative" Into ROS?

Answer: If the podiatrist always marks "all others negative" in the electronic medical record (EMR) for his review of systems (ROS) instead of checking off boxes, you may be able to find ROS elements in the history of present illness (HPI). However, keep in mind that there are no numerical requirements for how many systems the podiatrist must document in conjunction with the "all others negative" statement. It's up to the podiatrist to decide how many systems are pertinent to the complaint.

Because the documentation guidelines say, "positive or pertinent negative responses," if the podiatrist indicates positive or negative for at least one system and checks the "all others negative" box, then he has documented a complete ROS.

You need that one system: While the decision about ROS is ultimately the podiatrist's, he shouldn't consider checking the "all others negative" box a complete ROS when he hasn't evaluated any other systems. Without documentation of positive or negative responses to at least one system, the "all others negative" statement has no value.

You can also have a problem if a podiatrist has a consistent pattern of checking the "all others negative" box with no variation in the ROS documentation. This is because auditors may be uncomfortable if all the charts look the same, particularly if they all have the ROS box checked. The medical necessity for a complete ROS for patients with minor complaints just isn't there if the only ROS element in every chart is that checked box.